Provider Demographics
NPI:1316399611
Name:UPWARD THERAPY LLC
Entity Type:Organization
Organization Name:UPWARD THERAPY LLC
Other - Org Name:UPWARD THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:ROMANCZUK
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:248-716-0061
Mailing Address - Street 1:6632 TELEGRAPH RD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-3012
Mailing Address - Country:US
Mailing Address - Phone:248-716-0061
Mailing Address - Fax:
Practice Address - Street 1:181 COLEMAN DR
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3611
Practice Address - Country:US
Practice Address - Phone:248-716-0061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty