Provider Demographics
NPI:1518397348
Name:INNER CONNECTIONS LLC
Entity Type:Organization
Organization Name:INNER CONNECTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MINTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:248-318-6654
Mailing Address - Street 1:6400 FARMINGTON RD
Mailing Address - Street 2:STE 114
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4454
Mailing Address - Country:US
Mailing Address - Phone:248-318-6654
Mailing Address - Fax:248-562-3031
Practice Address - Street 1:6400 FARMINGTON RD
Practice Address - Street 2:STE 114
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4454
Practice Address - Country:US
Practice Address - Phone:248-318-6654
Practice Address - Fax:248-562-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty