Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201009828 | MI |
NPI | 1003316753 |
---|---|
Provider Name | Michelle Lynne Brisse |
First Address | Rochester, MI 48306-2441 |
Second Address | Ann Arbor, MI 48109-4000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2018 |
Last Update Date | 17/03/2018 |