Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 5201007350 | MI |
NPI | 1083181184 |
---|---|
Provider Name | Jill Constantakis |
First Address | Dearborn Heights, MI 48127-2920 |
Second Address | Dearborn Heights, MI 48127-2920 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2018 |
Last Update Date | 26/10/2018 |