Provider Demographics
NPI:1013490713
Name:LOEFFLER, MICHELE (OTR-L)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:LOEFFLER
Suffix:
Gender:F
Credentials:OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2134 HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1434
Mailing Address - Country:US
Mailing Address - Phone:313-461-2626
Mailing Address - Fax:
Practice Address - Street 1:19840 HARPER AVE
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1804
Practice Address - Country:US
Practice Address - Phone:313-881-9556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201002937225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5201002937OtherOCCUPATIONAL THERAPIST LICENSE
MI5201002937Medicaid