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NPI Code Detail

MEDICARE: MRS. CYNTHIA DIANE TINCKNELL OTRL

MEDICARE: MRS. CYNTHIA DIANE TINCKNELL OTRL
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 Therapist5201000001MI

General Provider Information

NPI Number : 1710464888
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CYNTHIA DIANE TINCKNELL OTRL
Provider Business Mailing Address
First Line : 790 SHOREHAM RD
Second Line :
City : GROSSE POINTE WOODS
State : MI
Zip : 48236-2446
Country : US
Telephone Number : 313-300-0016
Fax Number :
Provider Business Practice Location Address
First Line : 5201 CONNER ST
Second Line :
City : DETROIT
State : MI
Zip : 48213-3405
Country : US
Telephone Number : 313-571-5555
Fax Number : 313-925-1315
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2018
Last Update Date : 07/23/2018

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Directions to “ MRS. CYNTHIA DIANE TINCKNELL OTRL” Practice Location

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