Provider Demographics
NPI:1518597459
Name:DOUCETTE, DAVID N (OTR)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:N
Last Name:DOUCETTE
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 W CONWAY RD
Mailing Address - Street 2:
Mailing Address - City:HARBOR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49740-9684
Mailing Address - Country:US
Mailing Address - Phone:231-487-6163
Mailing Address - Fax:
Practice Address - Street 1:1171 W CONWAY RD
Practice Address - Street 2:
Practice Address - City:HARBOR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49740-9684
Practice Address - Country:US
Practice Address - Phone:231-487-6163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010788225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist