Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201010227 | MI |
NPI | 1003386269 |
---|---|
Provider Name | Jordan Anderson |
First Address | Saint Joseph, MI 49085-2112 |
Second Address | Saint Joseph, MI 49085-2112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2018 |
Last Update Date | 30/11/2018 |