Provider Demographics
NPI:1760175293
Name:TYLER, SHANELE (OTD, OTRL)
Entity Type:Individual
Prefix:
First Name:SHANELE
Middle Name:
Last Name:TYLER
Suffix:
Gender:F
Credentials:OTD, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6684 COTTONWOOD KNL
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3841
Mailing Address - Country:US
Mailing Address - Phone:248-982-0295
Mailing Address - Fax:
Practice Address - Street 1:2045 E WEST MAPLE RD STE D407
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390-3801
Practice Address - Country:US
Practice Address - Phone:248-926-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201013377225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist