Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201000460 | MI |
NPI | 1376126391 |
---|---|
Provider Name | Donna Lynn Ralston |
First Address | Washington Twp, MI 48095-2035 |
Second Address | Washington Twp, MI 48095-2035 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2021 |
Last Update Date | 29/04/2021 |