Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1336628353 |
---|---|
Provider Name | Lisa Marie Miranti |
First Address | Chesterfield, MI 48047-4145 |
Second Address | Fraser, MI 48026-2017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2018 |
Last Update Date | 09/08/2018 |