Provider Demographics
NPI:1114228764
Name:SEN, RANJAN (OTR)
Entity Type:Individual
Prefix:MR
First Name:RANJAN
Middle Name:
Last Name:SEN
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31207 LAKEVIEW BLVD
Mailing Address - Street 2:APT. 2207
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-2853
Mailing Address - Country:US
Mailing Address - Phone:248-624-7133
Mailing Address - Fax:360-323-4152
Practice Address - Street 1:31207 LAKEVIEW BLVD
Practice Address - Street 2:APT. 2207
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-2853
Practice Address - Country:US
Practice Address - Phone:248-624-7133
Practice Address - Fax:360-323-4152
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-14
Last Update Date:2010-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003612225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist