Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201009221 | MI |
NPI | 1033691704 |
---|---|
Provider Name | Jonathan Paul Groszek |
First Address | Gaylord, MI 49735-1560 |
Second Address | Gaylord, MI 49735-1560 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2018 |
Last Update Date | 30/08/2018 |