Provider Demographics
NPI:1639664147
Name:DUMAS, MARY B (OTRL)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:B
Last Name:DUMAS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:B
Other - Last Name:ENGELBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14722 PRAIRIE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-8826
Mailing Address - Country:US
Mailing Address - Phone:920-268-8803
Mailing Address - Fax:
Practice Address - Street 1:325 E EISENHOWER PKWY
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-3364
Practice Address - Country:US
Practice Address - Phone:734-763-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist