Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 5201006346 | MI |
NPI | 1013229467 |
---|---|
Provider Name | Jennifer Larue |
First Address | Howell, MI 48843-2168 |
Second Address | Howell, MI 48843-2168 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2010 |
Last Update Date | 31/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5201006346 | OCCUPATIONAL THERAPIST LICENSE (01) | MI |