Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201011111 | MI |
NPI | 1003405747 |
---|---|
Provider Name | Lee Austin Wilford |
First Address | Midland, MI 48642-7294 |
Second Address | Rochester, MI 48307-7206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2021 |
Last Update Date | 30/03/2021 |