Provider Demographics
NPI:1972654630
Name:SABENS, THERESA LYNN (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:LYNN
Last Name:SABENS
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 1:6300 22 MILE RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317
Mailing Address - Country:US
Mailing Address - Phone:586-330-0872
Mailing Address - Fax:866-630-0604
Practice Address - Street 1:6300 22 MILE RD STE 5
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-2106
Practice Address - Country:US
Practice Address - Phone:586-330-0872
Practice Address - Fax:866-630-0604
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1459225X00000X
MI5201005929225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOT3738Medicaid
AK1023596Medicaid