Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 056009168 | IL |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 1198 | HI |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201009379 | MI |
NPI | 1336430222 |
---|---|
Provider Name | Amy Frances Underwood |
First Address | Benton Harbor, MI 49022-3436 |
Second Address | Benton Harbor, MI 49022-9210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2011 |
Last Update Date | 18/01/2017 |