MEDICARE: ERICA COUVREUR

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
1	225X00000X	Occupational Therapist	5201009112	MI

General Provider Information

NPI Number	:	1336521160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA COUVREUR

Provider Business Mailing Address
First Line	:	20825 ARDMORE PARK DR
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48081-1809
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20825 ARDMORE PARK DR
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48081-1809
Country	:	US
Telephone Number	:	800-330-7711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2015
Last Update Date	:	06/29/2015

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