Provider Demographics
NPI:1003459207
Name:RIBEN, PEMINA (OT)
Entity Type:Individual
Prefix:
First Name:PEMINA
Middle Name:
Last Name:RIBEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6737 EDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-2833
Mailing Address - Country:US
Mailing Address - Phone:248-854-0313
Mailing Address - Fax:
Practice Address - Street 1:7125 ORCHARD LAKE RD STE 201
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3630
Practice Address - Country:US
Practice Address - Phone:248-865-9418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201004720225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist