Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201010385 | MI |
NPI | 1134701105 |
---|---|
Provider Name | Carly O'brien |
First Address | Manistee, MI 49660-9318 |
Second Address | Manistee, MI 49660-9318 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2021 |
Last Update Date | 28/04/2021 |