Provider Demographics
NPI:1477041432
Name:ANTEAU, ATHENA ISIS (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:ATHENA
Middle Name:ISIS
Last Name:ANTEAU
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8041 FAIRVIEW CT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-9242
Mailing Address - Country:US
Mailing Address - Phone:734-645-7058
Mailing Address - Fax:
Practice Address - Street 1:1201 E MICHIGAN AVE STE 320
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1854
Practice Address - Country:US
Practice Address - Phone:517-205-7633
Practice Address - Fax:517-205-7634
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201005217225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand