Individual
TANICIA WHITESIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
13794 21 MILE RD, SHELBY TOWNSHIP, MI 48315-4854
(586) 532-2100
Mailing address
26427 CATHEDRAL, REDFORD, MI 48239-1846
(248) 219-4758
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202006157
MI
Other
Enumeration date
08/15/2015
Last updated
08/15/2015
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