Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201001479 | MI |
NPI | 1285137356 |
---|---|
Provider Name | Joan Marie Smith |
First Address | Sault S Marie, MI 49783-3768 |
Second Address | Saint Ignace, MI 49781-1048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2018 |
Last Update Date | 14/03/2018 |