Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201005230 | MI |
NPI | 1003479114 |
---|---|
Provider Name | Joseph Thaddeus Smolarkiewicz |
First Address | Plainwell, MI 49080-1217 |
Second Address | Wayland, MI 49348-1109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2019 |
Last Update Date | 16/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5201005230 | STATE LICENSE NUMBER (01) | MI |