Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 520226817 | MI |
NPI | 1013493915 |
---|---|
Provider Name | Jodi Kramer |
First Address | Byron Center, MI 49315-8276 |
Second Address | Grandville, MI 49418-1854 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2018 |
Last Update Date | 13/07/2018 |