Provider Demographics
NPI:1902360803
Name:DOXTATOR, BRIGITTE
Entity Type:Individual
Prefix:
First Name:BRIGITTE
Middle Name:
Last Name:DOXTATOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 E MICHIGAN AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4345
Mailing Address - Country:US
Mailing Address - Phone:517-364-8600
Mailing Address - Fax:
Practice Address - Street 1:3315 E MICHIGAN AVE STE 4
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4345
Practice Address - Country:US
Practice Address - Phone:517-364-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201002456224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant