Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 520100894 | MI |
NPI | 1558934703 |
---|---|
Provider Name | Maureen Louise Fallon-Krueger |
First Address | Norton Shores, MI 49444-9786 |
Second Address | Grand Rapids, MI 49503-1375 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2021 |
Last Update Date | 23/07/2021 |