Provider Demographics
NPI:1790372050
Name:RICE, DESMOND RANDELL
Entity Type:Individual
Prefix:MR
First Name:DESMOND
Middle Name:RANDELL
Last Name:RICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30177 CASCADE CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2065
Mailing Address - Country:US
Mailing Address - Phone:313-575-2432
Mailing Address - Fax:
Practice Address - Street 1:30177 CASCADE CT
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2065
Practice Address - Country:US
Practice Address - Phone:313-575-2432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003933225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist