Provider Demographics
NPI:1922439579
Name:FAITEL, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:FAITEL
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 1:28555 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2973
Mailing Address - Country:US
Mailing Address - Phone:248-788-4300
Mailing Address - Fax:248-605-8099
Practice Address - Street 1:6892 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3032
Practice Address - Country:US
Practice Address - Phone:248-788-4300
Practice Address - Fax:248-605-8099
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202001112224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant