Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201009531 | MI |
NPI | 1003384058 |
---|---|
Provider Name | Amber Michelle Roy |
First Address | Highland, MI 48357-2601 |
Second Address | Bingham Farms, MI 48025-4573 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2018 |
Last Update Date | 07/11/2018 |