Provider Demographics
NPI:1891257507
Name:PHILLIPS, MONICA LEE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:LEE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30072 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:GOBLES
Mailing Address - State:MI
Mailing Address - Zip Code:49055-9698
Mailing Address - Country:US
Mailing Address - Phone:269-569-5012
Mailing Address - Fax:
Practice Address - Street 1:30072 23RD AVE
Practice Address - Street 2:
Practice Address - City:GOBLES
Practice Address - State:MI
Practice Address - Zip Code:49055-9698
Practice Address - Country:US
Practice Address - Phone:269-569-5012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4093225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist