Provider Demographics
NPI:1184893802
Name:KOZUB, SUE ELLEN (OTR/CHT)
Entity type:Individual
Prefix:MR
First Name:SUE
Middle Name:ELLEN
Last Name:KOZUB
Suffix:
Gender:F
Credentials:OTR/CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 BARCLAY CIR
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4774
Mailing Address - Country:US
Mailing Address - Phone:248-853-6965
Mailing Address - Fax:248-853-6972
Practice Address - Street 1:455 BARCLAY CIR
Practice Address - Street 2:SUITE B-1
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4774
Practice Address - Country:US
Practice Address - Phone:248-853-6965
Practice Address - Fax:248-853-6972
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201000446225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist