Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5201002728 | MI |
NPI | 1215130844 |
---|---|
Provider Name | Mr. Allan Thomas Priore |
First Address | Kalamazoo, MI 49048-1925 |
Second Address | Kalamazoo, MI 49048-1925 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2007 |
Last Update Date | 08/07/2007 |