Provider Demographics
NPI:1528190451
Name:SIDDIQUI, SEHRA SARWAR (OTR)
Entity Type:Individual
Prefix:
First Name:SEHRA
Middle Name:SARWAR
Last Name:SIDDIQUI
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38944 CHESHIRE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-9003
Mailing Address - Country:US
Mailing Address - Phone:248-548-6580
Mailing Address - Fax:313-593-3228
Practice Address - Street 1:13855 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2775
Practice Address - Country:US
Practice Address - Phone:248-548-6580
Practice Address - Fax:313-593-3228
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201005823225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236651Medicare ID - Type Unspecified