Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 5202008386 | MI |
NPI | 1013485184 |
---|---|
Provider Name | Clint M Northrop |
First Address | Swartz Creek, MI 48473-8543 |
Second Address | East Lansing, MI 48823-6376 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2018 |
Last Update Date | 07/11/2018 |