Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201005573 | MI |
NPI | 1003108838 |
---|---|
Provider Name | Kella Vadnais |
First Address | Fenton, MI 48430-1227 |
Second Address | Jackson, MI 49202-3398 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2011 |
Last Update Date | 06/12/2018 |