Provider Demographics
NPI:1205503976
Name:MI HOME LIFE THERAPY LLC
Entity type:Organization
Organization Name:MI HOME LIFE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:YATCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:734-961-5450
Mailing Address - Street 1:936 MADISON ST.
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-5294
Mailing Address - Country:US
Mailing Address - Phone:734-961-5450
Mailing Address - Fax:
Practice Address - Street 1:936 MADISON ST.
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-5294
Practice Address - Country:US
Practice Address - Phone:734-961-5450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty