Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 5202006894 | MI |
NPI | 1023443108 |
---|---|
Provider Name | Frances S Kimble |
First Address | Petoskey, MI 49770-2752 |
Second Address | Harbor Springs, MI 49740-1166 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2013 |
Last Update Date | 09/09/2013 |