Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5201008749 | MI |
NPI | 1336683507 |
---|---|
Provider Name | Kristin Hansen |
First Address | Kingsley, MI 49649-9548 |
Second Address | Kingsley, MI 49649-9548 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2016 |
Last Update Date | 25/11/2020 |