Provider Demographics
NPI:1356823116
Name:A1 OCCUPATIONAL THERAPY LLC
Entity Type:Organization
Organization Name:A1 OCCUPATIONAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCIDO
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:586-540-7193
Mailing Address - Street 1:23265 NORTHWESTERN HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-7707
Mailing Address - Country:US
Mailing Address - Phone:248-996-9428
Mailing Address - Fax:
Practice Address - Street 1:23265 NORTHWESTERN HWY STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-7707
Practice Address - Country:US
Practice Address - Phone:248-996-9428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)