Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201002653 | MI |
NPI | 1003275900 |
---|---|
Provider Name | Dawn Terry |
First Address | Rochester, MI 48307-1877 |
Second Address | Rochester, MI 48307-1877 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2016 |
Last Update Date | 19/02/2016 |