Provider Demographics
NPI:1518466630
Name:BHANA, KUSUM (OTR/L)
Entity Type:Individual
Prefix:
First Name:KUSUM
Middle Name:
Last Name:BHANA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36195 POMPANO DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4581
Mailing Address - Country:US
Mailing Address - Phone:586-274-4229
Mailing Address - Fax:
Practice Address - Street 1:25990 CROCKER BLVD
Practice Address - Street 2:
Practice Address - City:HARRISON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48045-3450
Practice Address - Country:US
Practice Address - Phone:586-466-5324
Practice Address - Fax:586-466-5397
Is Sole Proprietor?:No
Enumeration Date:2018-02-04
Last Update Date:2018-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003527225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation