Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201000298 | MI |
NPI | 1255835815 |
---|---|
Provider Name | Kathleen Sue Hill |
First Address | East Jordan, MI 49727-8615 |
Second Address | East Jordan, MI 49727-9410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2018 |
Last Update Date | 20/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5201000298 | OTR MICHIGAN STATE LICENSE (01) | MI |