Provider Demographics
NPI:1730683665
Name:SCHUPRA, ELIZABETH THERESA (OTRL)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:THERESA
Last Name:SCHUPRA
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 1:2904 MASEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-1950
Mailing Address - Country:US
Mailing Address - Phone:248-229-8186
Mailing Address - Fax:
Practice Address - Street 1:5877 LIVERNOIS RD STE 101
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-3100
Practice Address - Country:US
Practice Address - Phone:248-828-3800
Practice Address - Fax:248-828-4226
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201001910225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist