Provider Demographics
NPI:1922285303
Name:BLECHMAN GOSS, KAREN L (OT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:BLECHMAN GOSS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:B
Other - Last Name:GOSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT
Mailing Address - Street 1:33900 HARPER AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-416-9100
Mailing Address - Fax:586-416-9103
Practice Address - Street 1:30100 TELEGRAPH RD
Practice Address - Street 2:STE 140
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4514
Practice Address - Country:US
Practice Address - Phone:248-385-0030
Practice Address - Fax:248-849-9980
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201002873225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist