Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201001785 | MI |
NPI | 1033778683 |
---|---|
Provider Name | Gayle Naomi Kokmeyer |
First Address | Kalamazoo, MI 49001-2836 |
Second Address | Kalamazoo, MI 49001-2836 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2019 |
Last Update Date | 07/06/2019 |