Provider Demographics
NPI:1679227995
Name:HIZAM, ABDULLAH NABIL (OTR)
Entity Type:Individual
Prefix:
First Name:ABDULLAH
Middle Name:NABIL
Last Name:HIZAM
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 1:26645 W 12 MILE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-7812
Mailing Address - Country:US
Mailing Address - Phone:248-223-4430
Mailing Address - Fax:
Practice Address - Street 1:26645 W 12 MILE RD STE 201
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-7812
Practice Address - Country:US
Practice Address - Phone:248-223-4430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-06
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201012743225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist