Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201009980 | MI |
NPI | 1003319567 |
---|---|
Provider Name | Melissa Elizabeth Crow |
First Address | Rockford, MI 49341-7203 |
Second Address | Grand Rapids, MI 49503-2529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2018 |
Last Update Date | 12/03/2018 |