Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 0006480 | CO |
NPI | 1417559220 |
---|---|
Provider Name | Abby Davenport |
First Address | Pinckney, MI 48169-9311 |
Second Address | Pinckney, MI 48169-9311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2020 |
Last Update Date | 16/11/2020 |