Provider Demographics
NPI:1922689710
Name:KISHMISH, JANEL KHALID (OTRL)
Entity Type:Individual
Prefix:
First Name:JANEL
Middle Name:KHALID
Last Name:KISHMISH
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:JANEL
Other - Middle Name:KHALID
Other - Last Name:KISHMISH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JANEL KISHMISH OTRL
Mailing Address - Street 1:34505 W 12 MILE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3286
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:775 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1383
Practice Address - Country:US
Practice Address - Phone:734-593-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI734-593-5600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist