Provider Demographics
NPI:1114177086
Name:ACHIEVE LIFE SKILLS MANAGEMENT AND INDEPENDENCE LLC
Entity Type:Organization
Organization Name:ACHIEVE LIFE SKILLS MANAGEMENT AND INDEPENDENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUTER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:248-470-6024
Mailing Address - Street 1:23870 WESLEY DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48335-3353
Mailing Address - Country:US
Mailing Address - Phone:248-470-6024
Mailing Address - Fax:
Practice Address - Street 1:23870 WESLEY DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48335-3353
Practice Address - Country:US
Practice Address - Phone:248-470-6024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty