Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201010430 | MI |
NPI | 1013550052 |
---|---|
Provider Name | Cherrelle Van Coppenolle |
First Address | Ferndale, MI 48220-2369 |
Second Address | Ferndale, MI 48220-2369 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2019 |
Last Update Date | 22/10/2019 |