Provider Demographics
NPI:1801502208
Name:MAXWELL, LIANE JOY (OT)
Entity type:Individual
Prefix:
First Name:LIANE
Middle Name:JOY
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:LIANE
Other - Middle Name:MURRAY
Other - Last Name:MAXWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:13019 PAULINE DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-3122
Mailing Address - Country:US
Mailing Address - Phone:888-770-7240
Mailing Address - Fax:248-403-8506
Practice Address - Street 1:13019 PAULINE DR
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-3122
Practice Address - Country:US
Practice Address - Phone:888-770-7240
Practice Address - Fax:248-403-8506
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics