Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5201005622 | MI |
NPI | 1922168988 |
---|---|
Provider Name | Adele Locicero Vitale |
First Address | Wyandotte, MI 48192-2620 |
Second Address | Wyandotte, MI 48192-2620 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 08/07/2007 |