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NPI Code Detail

MEDICARE: SUPRIYA RAVOOR OTR/L

MEDICARE:   SUPRIYA  RAVOOR  OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist5201007008MI

General Provider Information

NPI Number : 1245709617
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUPRIYA RAVOOR OTR/L
Provider Business Mailing Address
First Line : 925 W SOUTH BLVD
Second Line :
City : TROY
State : MI
Zip : 48085-1502
Country : US
Telephone Number : 248-729-4400
Fax Number :
Provider Business Practice Location Address
First Line : 925 W SOUTH BLVD
Second Line :
City : TROY
State : MI
Zip : 48085-1502
Country : US
Telephone Number : 248-729-4400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2018
Last Update Date : 11/15/2018

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Directions to “ SUPRIYA RAVOOR OTR/L” Practice Location

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