Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5201006328 | MI |
NPI | 1528561388 |
---|---|
Provider Name | Laurel Margaret Packard |
First Address | Belmont, MI 49306-8001 |
Second Address | Grand Rapids, MI 49503-2560 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2018 |
Last Update Date | 17/03/2018 |