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NPI Code Detail

MEDICARE: RUBY RONESSE DOCKERY- BOYKIN OTD

MEDICARE: RUBY RONESSE DOCKERY- BOYKIN OTD
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
1225XP0200XPediatric Occupational Therapist5201014072MI

General Provider Information

NPI Number : 1922547173
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUBY RONESSE DOCKERY- BOYKIN OTD
Provider Business Mailing Address
First Line : 30801 JEFFERSON AVE
Second Line :
City : SAINT CLAIR SHORES
State : MI
Zip : 48082-1732
Country : US
Telephone Number : 586-207-7379
Fax Number :
Provider Business Practice Location Address
First Line : 30801 JEFFERSON AVE
Second Line :
City : SAINT CLAIR SHORES
State : MI
Zip : 48082-1732
Country : US
Telephone Number : 586-201-7737
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2017
Last Update Date : 11/18/2024

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