Provider Demographics
NPI:1508915505
Name:CARUTHERS, STARR REBECCA (CTRS)
Entity Type:Individual
Prefix:MRS
First Name:STARR
Middle Name:REBECCA
Last Name:CARUTHERS
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:MS
Other - First Name:STARR
Other - Middle Name:REBECCA
Other - Last Name:FRITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CTRS
Mailing Address - Street 1:22022 SHARKEY ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-3664
Mailing Address - Country:US
Mailing Address - Phone:586-648-8200
Mailing Address - Fax:
Practice Address - Street 1:15000 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-1973
Practice Address - Country:US
Practice Address - Phone:313-245-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53614225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist