Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201006640 | MI |
N | 225XH1200X | Occupational Therapist - Hand | 5201006640 | MI |
NPI | 1245362060 |
---|---|
Provider Name | Melissa Lynn Daul |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Waterford, MI 48327-1970 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 14/11/2014 |