Provider Demographics
NPI:1922586759
Name:EMADAMERHO, KRISHAWN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KRISHAWN
Middle Name:
Last Name:EMADAMERHO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3371 S JOHN HIX RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-1053
Mailing Address - Country:US
Mailing Address - Phone:248-521-0669
Mailing Address - Fax:
Practice Address - Street 1:15400 TRENTON RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2075
Practice Address - Country:US
Practice Address - Phone:734-284-4620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003591225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist