Provider Demographics
NPI:1114656501
Name:NURTURE OCCUPATIONAL THERAPY, PLLC
Entity Type:Organization
Organization Name:NURTURE OCCUPATIONAL THERAPY, PLLC
Other - Org Name:LEAD THE WAY THERAPIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTRL
Authorized Official - Phone:616-308-0719
Mailing Address - Street 1:41850 W 11 MILE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1857
Mailing Address - Country:US
Mailing Address - Phone:616-308-0719
Mailing Address - Fax:
Practice Address - Street 1:41850 W 11 MILE RD STE 110
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1857
Practice Address - Country:US
Practice Address - Phone:616-308-0719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-09
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty