Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201001202 | MI |
NPI | 1003394008 |
---|---|
Provider Name | Lorraine Berta |
First Address | Brighton, MI 48116-8238 |
Second Address | Ann Arbor, MI 48105-2768 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2018 |
Last Update Date | 01/08/2018 |