Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 5202006073 | MI |
NPI | 1003440330 |
---|---|
Provider Name | Ilona Crowder |
First Address | Clio, MI 48420-1911 |
Second Address | Grand Blanc, MI 48439-8065 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2020 |
Last Update Date | 25/02/2020 |