Provider Demographics
NPI:1780107045
Name:VISGER, EMILY MAE (OT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MAE
Last Name:VISGER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26025 LAHSER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-2606
Mailing Address - Country:US
Mailing Address - Phone:248-663-1906
Mailing Address - Fax:248-663-1903
Practice Address - Street 1:26025 LAHSER RD STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-2606
Practice Address - Country:US
Practice Address - Phone:248-663-1906
Practice Address - Fax:248-663-1903
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009280225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist