Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 5202007213 | MI |
NPI | 1013586452 |
---|---|
Provider Name | Malori Bailey |
First Address | Flint, MI 48502-1901 |
Second Address | Flint, MI 48502-1901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2021 |
Last Update Date | 21/06/2021 |