Provider Demographics
NPI:1669517355
Name:DAVID, DENISE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:DAVID
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 1:19223 MERRIMAN RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152
Mailing Address - Country:US
Mailing Address - Phone:248-476-1086
Mailing Address - Fax:248-442-0701
Practice Address - Street 1:2600 UNION LAKE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-3588
Practice Address - Country:US
Practice Address - Phone:248-366-1118
Practice Address - Fax:248-366-1011
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201000861225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist