Provider Demographics
NPI:1760419048
Name:GULATI, KOMAL C (MHS OTR CHT)
Entity Type:Individual
Prefix:MS
First Name:KOMAL
Middle Name:C
Last Name:GULATI
Suffix:
Gender:F
Credentials:MHS OTR CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:15869 JOHNSON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-8013
Mailing Address - Country:US
Mailing Address - Phone:734-658-8459
Mailing Address - Fax:248-773-7638
Practice Address - Street 1:CELESTIAL INSTITUTE OF PLASTIC SURGERY
Practice Address - Street 2:42680, FORD RD
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1291
Practice Address - Country:US
Practice Address - Phone:734-658-8459
Practice Address - Fax:734-844-5703
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003133225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist