Provider Demographics
NPI:1447946421
Name:GMERICK, JAMIE MEGAN (OTRL)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:MEGAN
Last Name:GMERICK
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46737 PINE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-5722
Mailing Address - Country:US
Mailing Address - Phone:586-770-4014
Mailing Address - Fax:
Practice Address - Street 1:22700 GREATER MACK AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2016
Practice Address - Country:US
Practice Address - Phone:586-443-4910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201013302225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist