Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1023548609 |
---|---|
Provider Name | Marissa Ann Becker |
First Address | East Lansing, MI 48823-7754 |
Second Address | East Lansing, MI 48823-7754 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2017 |
Last Update Date | 15/06/2017 |