Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201003495 | MI |
NPI | 1003176454 |
---|---|
Provider Name | Alida Klein |
First Address | Brownstown, MI 48183-5412 |
Second Address | Monroe, MI 48162-7909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2012 |
Last Update Date | 19/05/2012 |