Provider Demographics
NPI:1801034376
Name:KUPTZ, DEBRA KOEPELE (MT-BC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:KOEPELE
Last Name:KUPTZ
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37497 CHARTER OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-2415
Mailing Address - Country:US
Mailing Address - Phone:734-673-7618
Mailing Address - Fax:
Practice Address - Street 1:42627 GARFIELD RD
Practice Address - Street 2:SUITE 214
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-5032
Practice Address - Country:US
Practice Address - Phone:586-228-5345
Practice Address - Fax:586-228-5393
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2806OtherCERTIFICATION BOARD FOR MUSIC THERAPISTS