Individual
MRS. AMIE DAWN DETHARIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
7800 W OUTER DR STE 300, DETROIT, MI 48235-3458
(313) 340-4442
Mailing address
29506 CLARITA ST, LIVONIA, MI 48152-1944
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201007935
MI
Other
Enumeration date
05/14/2012
Last updated
07/17/2019
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