Provider Demographics
NPI:1689846628
Name:DUBAY, LESSA AZNIV (OTR)
Entity type:Individual
Prefix:MRS
First Name:LESSA
Middle Name:AZNIV
Last Name:DUBAY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17022 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-1137
Mailing Address - Country:US
Mailing Address - Phone:586-556-0378
Mailing Address - Fax:
Practice Address - Street 1:17022 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042-1137
Practice Address - Country:US
Practice Address - Phone:586-556-0378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006047225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist