Provider Demographics
NPI:1881199172
Name:MAY, ANNELIESE CATHERINE (OTRL)
Entity Type:Individual
Prefix:
First Name:ANNELIESE
Middle Name:CATHERINE
Last Name:MAY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:ANNELIESE
Other - Middle Name:CATHERINE
Other - Last Name:PFRUENDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 BEARD ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6562
Mailing Address - Country:US
Mailing Address - Phone:810-982-9500
Mailing Address - Fax:
Practice Address - Street 1:1300 BEARD ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6562
Practice Address - Country:US
Practice Address - Phone:810-982-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007554225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist