Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5201009740 | MI |
NPI | 1497286314 |
---|---|
Provider Name | Jordan Michael Vincke |
First Address | Bay City, MI 48708-6344 |
Second Address | Bay City, MI 48706-2161 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2017 |
Last Update Date | 22/03/2017 |