Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201008008 | MI |
N | 225XG0600X | Occupational Therapist - Gerontology | 5201008008 | MI |
NPI | 1255800546 |
---|---|
Provider Name | Krista R Szymoniak |
First Address | Canton, MI 48187-3533 |
Second Address | Canton, MI 48187-3533 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2018 |
Last Update Date | 07/03/2020 |