Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201002277 | MI |
NPI | 1255811501 |
---|---|
Provider Name | Carol Homco |
First Address | Canton, MI 48187-1512 |
Second Address | Ann Arbor, MI 48105-2768 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2018 |
Last Update Date | 16/08/2018 |