Provider Demographics
NPI:1548712243
Name:ROYAL OAK PEDIATRIC THERAPIES, LLC
Entity type:Organization
Organization Name:ROYAL OAK PEDIATRIC THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-972-1292
Mailing Address - Street 1:419 W BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-2567
Mailing Address - Country:US
Mailing Address - Phone:734-972-1292
Mailing Address - Fax:
Practice Address - Street 1:419 W BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-2567
Practice Address - Country:US
Practice Address - Phone:734-972-1292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty