Provider Demographics
NPI: | 1033964697 |
---|---|
Name: | OAKLAND MYO AND WELLNESS INSTITUTE, LLC |
Entity Type: | Organization |
Organization Name: | OAKLAND MYO AND WELLNESS INSTITUTE, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER, DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MICHELLE |
Authorized Official - Middle Name: | R |
Authorized Official - Last Name: | RICHARDS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MA, CCC-SLP |
Authorized Official - Phone: | 586-557-3600 |
Mailing Address - Street 1: | 48196 CONIFER DR |
Mailing Address - Street 2: | |
Mailing Address - City: | SHELBY TOWNSHIP |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48315-6804 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 586-557-3600 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 410 W UNIVERSITY DR STE A |
Practice Address - Street 2: | |
Practice Address - City: | ROCHESTER |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48307-1938 |
Practice Address - Country: | US |
Practice Address - Phone: | 248-266-5438 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2024-04-18 |
Last Update Date: | 2024-04-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty |