Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 5202006620 | MI |
NPI | 1003128174 |
---|---|
Provider Name | Bryan James Roberts |
First Address | Midland, MI 48642-9316 |
Second Address | Midland, MI 48642-9316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2010 |
Last Update Date | 06/07/2010 |