Provider Demographics
NPI:1881613750
Name:THERAMAX
Entity type:Organization
Organization Name:THERAMAX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:BERTHA
Authorized Official - Last Name:WEINGARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:586-566-8913
Mailing Address - Street 1:52700 FAIRCHILD RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-1976
Mailing Address - Country:US
Mailing Address - Phone:586-949-7111
Mailing Address - Fax:
Practice Address - Street 1:49050 SCHOENHERR RD
Practice Address - Street 2:SUITE 600
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-3856
Practice Address - Country:US
Practice Address - Phone:586-566-8913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201000119261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center