Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5201007941 | MI |
NPI | 1629664149 |
---|---|
Provider Name | Melissa Rudolph |
First Address | Howell, MI 48843-1405 |
Second Address | Brighton, MI 48116-7411 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2020 |
Last Update Date | 18/12/2020 |