Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201008218 | MI |
N | 225XG0600X | Occupational Therapist - Gerontology | 5201008218 | MI |
NPI | 1033548078 |
---|---|
Provider Name | James Baxter |
First Address | Sault Sainte Marie, MI 49783-0507 |
Second Address | Sault Sainte Marie, MI 49783-2650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2013 |
Last Update Date | 08/11/2013 |