Provider Demographics
NPI:1669039350
Name:BUHNERKEMPER, ALICIA
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:BUHNERKEMPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19853 OUTER DR STE 110
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2044
Mailing Address - Country:US
Mailing Address - Phone:313-406-5056
Mailing Address - Fax:248-712-4381
Practice Address - Street 1:23537 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48134-9330
Practice Address - Country:US
Practice Address - Phone:313-278-4601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2025-07-30
Deactivation Date:2025-06-21
Deactivation Code:
Reactivation Date:2025-07-30
Provider Licenses
StateLicense IDTaxonomies
156F00000X
MI5201014254225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No156F00000XEye and Vision Services ProvidersTechnician/Technologist