1861523151 NPI number — MRS. LAURA MARGARET RUPPENTHAL OTR CHT

Table of content: MRS. LAURA MARGARET RUPPENTHAL OTR CHT (NPI 1861523151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861523151 NPI number — MRS. LAURA MARGARET RUPPENTHAL OTR CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUPPENTHAL
Provider First Name:
LAURA
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR CHT
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:
1861523151
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5798 HIGHLAND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERFORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48327-1826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-724-4400
Provider Business Mailing Address Fax Number:
248-724-4405

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1282 KIRTS BLVD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48084-4890
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-918-5560
Provider Business Practice Location Address Fax Number:
248-918-5565
Provider Enumeration Date:
03/08/2007

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: 225XH1200X , with the licence number:  5201002188 , 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)





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