Provider Demographics
NPI:1497557912
Name:APOLONIO, REGINALD
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:
Last Name:APOLONIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45243 COTTONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-4960
Mailing Address - Country:US
Mailing Address - Phone:586-481-5958
Mailing Address - Fax:
Practice Address - Street 1:1255 W SILVERBELL RD
Practice Address - Street 2:
Practice Address - City:ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-1345
Practice Address - Country:US
Practice Address - Phone:248-391-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI520200847224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant