Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201002851 | MI |
NPI | 1023389632 |
---|---|
Provider Name | Debora Deren |
First Address | White Lake, MI 48383-2802 |
Second Address | Clinton Twp, MI 48035-3212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2012 |
Last Update Date | 13/01/2012 |