Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | MI | |
N | 225XG0600X | Occupational Therapist - Gerontology | MI |
NPI | 1124521869 |
---|---|
Provider Name | Karry Lynn Wilson |
First Address | Byron, MI 48418-9773 |
Second Address | Owosso, MI 48867 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2018 |
Last Update Date | 08/03/2018 |