Provider Demographics
NPI:1104142587
Name:DADUVAI, POOJA (OT)
Entity type:Individual
Prefix:
First Name:POOJA
Middle Name:
Last Name:DADUVAI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4372 SHERWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2209
Mailing Address - Country:US
Mailing Address - Phone:734-495-0537
Mailing Address - Fax:734-495-0537
Practice Address - Street 1:4372 SHERWOOD CIR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-2209
Practice Address - Country:US
Practice Address - Phone:734-495-0537
Practice Address - Fax:734-495-0537
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-11
Last Update Date:2010-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201004211225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist