Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 5201003232 | MI |
NPI | 1174093777 |
---|---|
Provider Name | Brooke Deann Barry |
First Address | Oxford, MI 48371-6720 |
Second Address | Oxford, MI 48371-6720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2018 |
Last Update Date | 27/11/2018 |