Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225700000X | Massage Therapist | 7501001926 | MI |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201003917 | MI |
NPI | 1164994588 |
---|---|
Provider Name | Beverly Eleas Lahr |
First Address | Wayne, MI 48184-0275 |
Second Address | Farmington Hills, MI 48331-3258 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/12/2018 |
Last Update Date | 24/12/2018 |