Provider Demographics
NPI:1669975140
Name:DEWITT, GENEVIEVE LEE (OTRL)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:LEE
Last Name:DEWITT
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 W LIBERTY RD
Mailing Address - Street 2:STE F
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9180
Mailing Address - Country:US
Mailing Address - Phone:734-936-7070
Mailing Address - Fax:
Practice Address - Street 1:3200 W LIBERTY RD STE F
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9180
Practice Address - Country:US
Practice Address - Phone:734-369-6002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009680225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist