Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201009326 | MI |
NPI | 1144707449 |
---|---|
Provider Name | Elise Pomerleau |
First Address | Windsor, ONTARIO N8T2H3 |
Second Address | Taylor, MI 48180-4019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2018 |
Last Update Date | 19/07/2018 |