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NPI Code Detail

MEDICARE: DERELLIA DONALD

MEDICARE: DERELLIA DONALD
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1841123494
Entity Type Code : Individual
Provider Name (Legal Business Name) : DERELLIA DONALD
Provider Business Mailing Address
First Line : 2805 S INDUSTRIAL HWY STE 100
Second Line :
City : ANN ARBOR
State : MI
Zip : 48104-6791
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1625 CONCENTRIC BLVD
Second Line :
City : SAGINAW
State : MI
Zip : 48604-9542
Country : US
Telephone Number : 989-262-0633
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2026
Last Update Date : 06/04/2026

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Directions to “ DERELLIA DONALD ” Practice Location

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