Provider Demographics
NPI:1184863045
Name:OT BOB
Entity Type:Organization
Organization Name:OT BOB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR
Authorized Official - Phone:248-760-5521
Mailing Address - Street 1:2098 MAPLERIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-4504
Mailing Address - Country:US
Mailing Address - Phone:248-760-5521
Mailing Address - Fax:
Practice Address - Street 1:2098 MAPLERIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-4504
Practice Address - Country:US
Practice Address - Phone:248-760-5521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health