Provider Demographics
NPI:1124413224
Name:GOODNIGHT, EMILIE (OTL)
Entity Type:Individual
Prefix:
First Name:EMILIE
Middle Name:
Last Name:GOODNIGHT
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28555 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2973
Mailing Address - Country:US
Mailing Address - Phone:248-788-4300
Mailing Address - Fax:
Practice Address - Street 1:6892 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3032
Practice Address - Country:US
Practice Address - Phone:248-788-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009093225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist