Provider Demographics
NPI:1609451418
Name:EWALD, NATALIE (OTRL)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:EWALD
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:EWALD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:44201 DEQUINDRE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-1117
Mailing Address - Country:US
Mailing Address - Phone:248-964-4014
Mailing Address - Fax:
Practice Address - Street 1:44201 DEQUINDRE RD STE 203
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1117
Practice Address - Country:US
Practice Address - Phone:248-964-4014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-12
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI446920225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist