Provider Demographics
NPI:1750546651
Name:NAFSOU, MARI (OTR/L, CLT)
Entity type:Individual
Prefix:MS
First Name:MARI
Middle Name:
Last Name:NAFSOU
Suffix:
Gender:F
Credentials:OTR/L, CLT
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:NAFSOU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L, CLT
Mailing Address - Street 1:2498 S ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-7955
Mailing Address - Country:US
Mailing Address - Phone:248-495-0806
Mailing Address - Fax:248-212-0143
Practice Address - Street 1:2498 S ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-3817
Practice Address - Country:US
Practice Address - Phone:248-495-0806
Practice Address - Fax:248-212-0143
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201005775225XH1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Medicaid