Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 5201010645 | MI |
NPI | 1003465071 |
---|---|
Provider Name | Kelly Gottschall |
First Address | Plainwell, MI 49080-1955 |
Second Address | Plainwell, MI 49080-1955 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2019 |
Last Update Date | 11/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5201010645 | STATE OF MICHIGAN (01) | MI |