Provider Demographics
NPI:1932538550
Name:LANG, DORIS NYARADZAI (COTA)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:NYARADZAI
Last Name:LANG
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:DORIS
Other - Middle Name:NYARADZAI
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:3040 WATERCHASE WAY SW APT 312
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-5955
Mailing Address - Country:US
Mailing Address - Phone:616-719-7353
Mailing Address - Fax:
Practice Address - Street 1:2786 56TH ST SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49418-8708
Practice Address - Country:US
Practice Address - Phone:616-261-3960
Practice Address - Fax:616-261-3925
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI520007194224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant