MEDICARE: ALISA MICHELLE CIOKAJLO

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	5201000957	MI

General Provider Information

NPI Number	:	1437178480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISA MICHELLE CIOKAJLO

Provider Business Mailing Address
First Line	:	25333 LIBERTY LN
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48335-1239
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19701 VERNIER RD
Second Line	:
City	:	HARPER WOODS
State	:	MI
Zip	:	48225-1467
Country	:	US
Telephone Number	:	313-884-8920
Fax Number	:

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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