Provider Demographics
NPI:1447514013
Name:MAHFOUZ-ALKOTOB, RUBA
Entity type:Individual
Prefix:MRS
First Name:RUBA
Middle Name:
Last Name:MAHFOUZ-ALKOTOB
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 1:5084 VILLA LINDE PKWY
Mailing Address - Street 2:SUITE 7A
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3422
Mailing Address - Country:US
Mailing Address - Phone:810-720-3891
Mailing Address - Fax:810-720-3916
Practice Address - Street 1:5084 VILLA LINDE PKWY
Practice Address - Street 2:SUITE 7A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3422
Practice Address - Country:US
Practice Address - Phone:810-720-3891
Practice Address - Fax:810-720-3916
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003788225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist