Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5201004147 | MI |
NPI | 1700216975 |
---|---|
Provider Name | Mr. Jeffrey Wilbur |
First Address | Clinton Twp, MI 48038-1361 |
Second Address | Farmington Hills, MI 48334-2973 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2013 |
Last Update Date | 25/11/2013 |