Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201007220 | MI |
NPI | 1003310848 |
---|---|
Provider Name | Jessica Michelle Flood |
First Address | Cedar Springs, MI 49319-9420 |
Second Address | Grand Rapids, MI 49525-8614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2018 |
Last Update Date | 19/03/2018 |