Provider Demographics
NPI:1619703105
Name:JANSSEN, RILEY (OTRL)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:JANSSEN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11878 HUBBARD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1733
Mailing Address - Country:US
Mailing Address - Phone:734-743-2909
Mailing Address - Fax:734-953-1743
Practice Address - Street 1:15500 19 MILE RD STE 330
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-6313
Practice Address - Country:US
Practice Address - Phone:586-412-0016
Practice Address - Fax:586-412-0117
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201013983225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist