Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201000195 | MI |
NPI | 1003318874 |
---|---|
Provider Name | Karen Watson |
First Address | Brighton, MI 48116-9549 |
Second Address | Farmington Hills, MI 48336-5919 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2018 |
Last Update Date | 07/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1336183367 | (05) | MI |