Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5201003396 | MI |
NPI | 1619116928 |
---|---|
Provider Name | Monica Lor Novak |
First Address | Okemos, MI 48864-4030 |
Second Address | East Lansing, MI 48823-7755 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2009 |
Last Update Date | 31/08/2016 |