Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 32001095A | IN |
NPI | 1013125533 |
---|---|
Provider Name | Irma Perez |
First Address | New Buffalo, MI 49117-1174 |
Second Address | Michigan City, IN 46360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 08/07/2007 |