Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201006731 | MI |
NPI | 1003292053 |
---|---|
Provider Name | Deborah E. Ruediger |
First Address | Plymouth, MI 48170-1621 |
Second Address | Grand Rapids, MI 49505-3313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2015 |
Last Update Date | 31/07/2015 |