Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5201007735 | MI |
NPI | 1730680612 |
---|---|
Provider Name | Christine Marion Koch |
First Address | Birmingham, MI 48009-4712 |
Second Address | Royal Oak, MI 48073-1026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2018 |
Last Update Date | 26/02/2018 |