Provider Demographics
NPI:1558688275
Name:SEEFRIED, MARIEA ELENA
Entity Type:Individual
Prefix:
First Name:MARIEA
Middle Name:ELENA
Last Name:SEEFRIED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIEA
Other - Middle Name:ELENA
Other - Last Name:SHERRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15641 27 MILE RD
Mailing Address - Street 2:
Mailing Address - City:RAY
Mailing Address - State:MI
Mailing Address - Zip Code:48096-3405
Mailing Address - Country:US
Mailing Address - Phone:586-337-3915
Mailing Address - Fax:
Practice Address - Street 1:17470 27 MILE RD
Practice Address - Street 2:
Practice Address - City:RAY
Practice Address - State:MI
Practice Address - Zip Code:48096-3509
Practice Address - Country:US
Practice Address - Phone:586-677-3771
Practice Address - Fax:888-207-3002
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201000191225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist