Provider Demographics
NPI:1891174587
Name:MANSOUR, REEM MARIAM (MOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:REEM
Middle Name:MARIAM
Last Name:MANSOUR
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:MS
Other - First Name:REEM
Other - Middle Name:MARIAM
Other - Last Name:BATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:8684 GOLF LANE DR.
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44125 WEST 12 MILE RD E-123
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377
Practice Address - Country:US
Practice Address - Phone:248-952-4340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009132225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist