Provider Demographics
NPI:1497029227
Name:THERAPEUTICALLY DESIGNED INC.
Entity Type:Organization
Organization Name:THERAPEUTICALLY DESIGNED INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:PIERCE
Authorized Official - Last Name:TIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:ORT/L
Authorized Official - Phone:248-789-0232
Mailing Address - Street 1:19785 W 12 MILE RD # 287
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2584
Mailing Address - Country:US
Mailing Address - Phone:248-789-0232
Mailing Address - Fax:
Practice Address - Street 1:19785 W 12 MILE RD # 287
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2584
Practice Address - Country:US
Practice Address - Phone:248-789-0232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251300000X, 251V00000X, 252Y00000X, 253J00000X, 320800000X, 332BC3200X
MI5201002048252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251300000XAgenciesLocal Education Agency (LEA)
No251V00000XAgenciesVoluntary or Charitable
No253J00000XAgenciesFoster Care Agency
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment