Provider Demographics
NPI:1356830301
Name:IQBAL, ALINA
Entity Type:Individual
Prefix:
First Name:ALINA
Middle Name:
Last Name:IQBAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45202 DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1047
Mailing Address - Country:US
Mailing Address - Phone:734-837-0652
Mailing Address - Fax:
Practice Address - Street 1:33742 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3358
Practice Address - Country:US
Practice Address - Phone:248-545-8306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010024225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI391181OtherNBCOT CERTIFICATION ID
MI5201010024OtherSTATE OF MICHIGAN OCCUPATIONAL THERAPY LICENSE