Provider Demographics
NPI:1730435942
Name:ROY, LINDA LORRAINE (COTA)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:LORRAINE
Last Name:ROY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:LORRAINE
Other - Last Name:DONNELLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6937 SOMERSET DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-8802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:43455 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-3100
Practice Address - Country:US
Practice Address - Phone:248-349-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202001118224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant