Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201011643 | MI |
NPI | 1003570961 |
---|---|
Provider Name | Kendra Osepchuk Sosa |
First Address | Bay City, MI 48706-2367 |
Second Address | Bay City, MI 48706-2367 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2021 |
Last Update Date | 27/10/2021 |