Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201000081 | MI |
NPI | 1033529888 |
---|---|
Provider Name | Gail Ann Shafer |
First Address | East Lansing, MI 48823-6916 |
Second Address | Lansing, MI 48911-4285 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2014 |
Last Update Date | 03/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5201000081 | STATE LICENSE (01) | MI |