Provider Demographics
NPI:1477701738
Name:BRETZ, FAY MARIE (ASSOCIATES DEGREE)
Entity Type:Individual
Prefix:MRS
First Name:FAY
Middle Name:MARIE
Last Name:BRETZ
Suffix:
Gender:F
Credentials:ASSOCIATES DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29626 ERIE CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-2242
Mailing Address - Country:US
Mailing Address - Phone:586-420-0807
Mailing Address - Fax:
Practice Address - Street 1:29626 ERIE CT
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-2242
Practice Address - Country:US
Practice Address - Phone:586-420-0807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child