Provider Demographics
NPI:1518320605
Name:LOSELLE, HEATHER LINDSAY (COTA/L)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LINDSAY
Last Name:LOSELLE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-3346
Mailing Address - Country:US
Mailing Address - Phone:810-772-3954
Mailing Address - Fax:
Practice Address - Street 1:11000 W MCNICHOLS RD
Practice Address - Street 2:SUITE 320
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2357
Practice Address - Country:US
Practice Address - Phone:313-340-4442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant