Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201007608 | MI |
NPI | 1174024525 |
---|---|
Provider Name | Joel Permoda Mann |
First Address | Lansing, MI 48915-1972 |
Second Address | Okemos, MI 48864-3704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2018 |
Last Update Date | 21/02/2018 |