Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 5201010599 | MI |
NPI | 1619533106 |
---|---|
Provider Name | Brianna Lee Solomon |
First Address | Freeland, MI 48623-9449 |
Second Address | Owosso, MI 48867-8844 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2019 |
Last Update Date | 10/05/2019 |