Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201005687 | MI |
NPI | 1225508567 |
---|---|
Provider Name | Kristen Radwan |
First Address | Dearborn Heights, MI 48127-2920 |
Second Address | Dearborn Heights, MI 48127-2920 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2018 |
Last Update Date | 29/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5201005687 | (05) | MI |