Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201011080 | MI |
NPI | 1184390031 |
---|---|
Provider Name | Irma Rekic |
First Address | Grand Rapids, MI 49503 |
Second Address | Grand Rapids, MI 49503-2560 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2021 |
Last Update Date | 20/08/2021 |