Provider Demographics
NPI:1093284473
Name:FOOTE, THERESE ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:ANN
Last Name:FOOTE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 E HURON RIVER DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9335
Mailing Address - Country:US
Mailing Address - Phone:734-975-2633
Mailing Address - Fax:
Practice Address - Street 1:4701 E HURON RIVER DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9335
Practice Address - Country:US
Practice Address - Phone:734-975-2633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201001581225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology