Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201002168 | MI |
NPI | 1003385477 |
---|---|
Provider Name | Karen Smith |
First Address | Troy, MI 48085-1502 |
Second Address | Troy, MI 48085-1502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2018 |
Last Update Date | 15/11/2018 |