Provider Demographics
NPI:1992058424
Name:HOME AND COMMUNITY RECREATION THERAPY
Entity type:Organization
Organization Name:HOME AND COMMUNITY RECREATION THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:PENNY
Authorized Official - Last Name:WAGNER-HEFFNER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CTRS
Authorized Official - Phone:734-355-3899
Mailing Address - Street 1:1810 TIMBER TRAIL
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103
Mailing Address - Country:US
Mailing Address - Phone:734-355-3899
Mailing Address - Fax:
Practice Address - Street 1:1810 TIMBER TRL
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-2392
Practice Address - Country:US
Practice Address - Phone:734-355-3899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Single Specialty