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Organization
WAVE MEDICAL CENTER PLLC
Active
Organization
WAVE MEDICAL CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NERGIS JASSIM OTR (ADMIN)
(313) 903-3338
Entity
Organization
Contact information
Practice address
17600 W WARREN AVE, DETROIT, MI 48228-3509
(313) 903-3338
Mailing address
21103 FAIRVIEW DR, DEARBORN HEIGHTS, MI 48127-2686
(313) 903-3338
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
106S00000X
Behavior Technician
—
—
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
—
—
225200000X
Physical Therapy Assistant
—
—
225X00000X
Occupational Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
11/11/2021
Last updated
11/13/2021
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