Provider Demographics
NPI:1679946032
Name:TLC OCCUPATIONAL THERAPY SERVICES, PLLC
Entity Type:Organization
Organization Name:TLC OCCUPATIONAL THERAPY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTRL
Authorized Official - Phone:734-740-4078
Mailing Address - Street 1:PO BOX 2993
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106-2993
Mailing Address - Country:US
Mailing Address - Phone:734-740-4078
Mailing Address - Fax:
Practice Address - Street 1:6655 JACKSON RD
Practice Address - Street 2:LOT 625
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9588
Practice Address - Country:US
Practice Address - Phone:734-740-4078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-07
Last Update Date:2015-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201000315251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health