Organization
SPECIAL TREE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GAVIN DREW MILNER (OCCUPATIONAL THERAPY ASSISTANT)
(313) 729-2942
Entity
Organization
Contact information
Practice address
39000 CHASE ST, ROMULUS, MI 48174-1303
(734) 893-1033
Mailing address
1551 BEAUFIELD ST, FERNDALE, MI 48220-1612
(313) 729-2942
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
9
MI
Other
Enumeration date
06/12/2013
Last updated
07/21/2022
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