Provider Demographics
NPI:1982379699
Name:NISHAT, FABIHA (OTR/L)
Entity type:Individual
Prefix:
First Name:FABIHA
Middle Name:
Last Name:NISHAT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11370 SOBIESKI ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-3154
Mailing Address - Country:US
Mailing Address - Phone:313-658-6870
Mailing Address - Fax:
Practice Address - Street 1:24901 NORTHWESTERN HWY STE 113
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2200
Practice Address - Country:US
Practice Address - Phone:844-369-9955
Practice Address - Fax:947-282-8576
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201011373225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist