Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201011279 | MI |
NPI | 1003487422 |
---|---|
Provider Name | Jessica Lynn Friend |
First Address | Canton, MI 48187-2150 |
Second Address | Canton, MI 48187-2150 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2021 |
Last Update Date | 07/07/2021 |