Provider Demographics
NPI:1700216975
Name:WILBUR, JEFFREY (OTL, CSCS)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:WILBUR
Suffix:
Gender:M
Credentials:OTL, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43889 RIVERGATE DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1361
Mailing Address - Country:US
Mailing Address - Phone:586-822-8209
Mailing Address - Fax:
Practice Address - Street 1:28555 ORCHARD LAKE RD
Practice Address - Street 2:SUITE #106
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2973
Practice Address - Country:US
Practice Address - Phone:248-788-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201004147225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation