Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201007534 | MI |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201007534 | MI |
NPI | 1114369204 |
---|---|
Provider Name | Kathleen Ann Krantz |
First Address | Royal Oak, MI 48067-4013 |
Second Address | Detroit, MI 48201-2120 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2013 |
Last Update Date | 18/07/2013 |