Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201008462 | MI |
N | 225XG0600X | Occupational Therapist - Gerontology | 5201008462 | MI |
NPI | 1568113157 |
---|---|
Provider Name | Deirdre Lieder |
First Address | Milford, MI 48381-2859 |
Second Address | Milford, MI 48381-2859 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2022 |
Last Update Date | 14/01/2022 |