Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5201008424 | MI |
NPI | 1457747685 |
---|---|
Provider Name | Jessica Ellinger |
First Address | Mason, MI 48854-9425 |
Second Address | Mason, MI 48854-9425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2015 |
Last Update Date | 08/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
305197 | NATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY (01) | |
5201008424 | OCCUPATIONAL THERAPIST LICENSE (01) | MI |