Provider Demographics
NPI:1902387640
Name:NASAUDEANU, ELIZA NAOMI (OTRL)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:NAOMI
Last Name:NASAUDEANU
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 1:17009 ELEANOR DR W APT 143
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6530
Mailing Address - Country:US
Mailing Address - Phone:313-587-6572
Mailing Address - Fax:
Practice Address - Street 1:17009 ELEANOR DR W APT 143
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-6530
Practice Address - Country:US
Practice Address - Phone:313-587-6572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009683225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist