Provider Demographics
NPI:1336212901
Name:DELISLE, JOANN KOCHEVAR (OTR,CHT)
Entity Type:Individual
Prefix:MS
First Name:JOANN
Middle Name:KOCHEVAR
Last Name:DELISLE
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 1:26336 E. HURON RIVER DR.
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLAT ROCK
Mailing Address - State:MI
Mailing Address - Zip Code:48134-1833
Mailing Address - Country:US
Mailing Address - Phone:734-789-8281
Mailing Address - Fax:734-789-8258
Practice Address - Street 1:26336 E. HURON RIVER DR.
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:MI
Practice Address - Zip Code:48134-1833
Practice Address - Country:US
Practice Address - Phone:734-789-8281
Practice Address - Fax:734-789-8258
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201000758225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N83760Medicare PIN