Provider Demographics
NPI:1902640808
Name:KLEM, ZARINA A (CTRS)
Entity type:Individual
Prefix:MS
First Name:ZARINA
Middle Name:A
Last Name:KLEM
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CTRS
Mailing Address - Street 1:3354 ASH DR APT 9107
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-1010
Mailing Address - Country:US
Mailing Address - Phone:248-877-9459
Mailing Address - Fax:
Practice Address - Street 1:38257 MOUND RD BLDG D
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-3466
Practice Address - Country:US
Practice Address - Phone:586-722-7524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI87155225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Single Specialty