Provider Demographics
NPI:1801698758
Name:JAIN, VIDHYA DINESH (COTA)
Entity type:Individual
Prefix:
First Name:VIDHYA
Middle Name:DINESH
Last Name:JAIN
Suffix:
Gender:
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28230 ORCHARD LAKE RD STE 215
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3764
Mailing Address - Country:US
Mailing Address - Phone:248-254-3582
Mailing Address - Fax:248-671-0632
Practice Address - Street 1:28230 ORCHARD LAKE RD STE 215
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3764
Practice Address - Country:US
Practice Address - Phone:248-254-3582
Practice Address - Fax:248-671-0632
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No251E00000XAgenciesHome Health
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness