1386708295 NPI number — ARCHANA SHIRISHKAR OTR

Table of content: ARCHANA SHIRISHKAR OTR (NPI 1386708295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386708295 NPI number — ARCHANA SHIRISHKAR OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIRISHKAR
Provider First Name:
ARCHANA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR
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:
1386708295
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38004 FRINGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STERLING HEIGHTS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48310-3053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-353-3260
Provider Business Mailing Address Fax Number:
248-353-3275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26699 W 12 MILE RD
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48034-1578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
242-353-3260
Provider Business Practice Location Address Fax Number:
248-353-3275
Provider Enumeration Date:
12/22/2006

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: 225X00000X , with the licence number:  5201001865 , 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: 5201001865 . This is a "OCCUPATIONAL THERAPY LICE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 670F302750 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".