Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 5201000132 | MI |
NPI | 1063986693 |
---|---|
Provider Name | Lani Jakovac |
First Address | Rockwood, MI 48173-8756 |
Second Address | Taylor, MI 48180-4613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2019 |
Last Update Date | 16/01/2019 |