Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 5201002005 | MI |
NPI | 1336617919 |
---|---|
Provider Name | Lisa Ann-Marie Garcia-Watson |
First Address | Allen Park, MI 48101-1436 |
Second Address | Allen Park, MI 48101-1436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2018 |
Last Update Date | 13/11/2018 |