1013229467 NPI number — JENNIFER LARUE OTRL

Table of content: JENNIFER LARUE OTRL (NPI 1013229467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013229467 NPI number — JENNIFER LARUE OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LARUE
Provider First Name:
JENNIFER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTRL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013229467
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
138 W HIGHLAND RD # RS
Provider Second Line Business Mailing Address:
SUITE 500-600
Provider Business Mailing Address City Name:
HOWELL
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48843-2168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-376-4831
Provider Business Mailing Address Fax Number:
517-376-4833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
138 W HIGHLAND RD # RS
Provider Second Line Business Practice Location Address:
SUITE 500-600
Provider Business Practice Location Address City Name:
HOWELL
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48843-2168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-376-4831
Provider Business Practice Location Address Fax Number:
517-376-4833
Provider Enumeration Date:
07/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X , with the licence number:  5201006346 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5201006346 . This is a "OCCUPATIONAL THERAPIST LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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