Provider Demographics
NPI:1700910379
Name:HORMUTH, BARBARA (MOT, OTR)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:HORMUTH
Suffix:
Gender:F
Credentials:MOT, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17981 WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-9015
Mailing Address - Country:US
Mailing Address - Phone:734-451-7800
Mailing Address - Fax:734-451-9540
Practice Address - Street 1:575 S MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1778
Practice Address - Country:US
Practice Address - Phone:734-451-7800
Practice Address - Fax:734-451-9540
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL697610101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)