Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 5201006390 | MI |
N | 225XH1200X | Occupational Therapist - Hand | 5201006390 | MI |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201006390 | MI |
NPI | 1023052412 |
---|---|
Provider Name | Mr. Joel M Phillips |
First Address | Kalamazoo, MI 49009-9462 |
Second Address | Kalamazoo, MI 49009-9462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 18/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023052412 | NPI (01) | MI |
155812 | GREAT LAKES HLTH PLN (01) | |
OP15760 | MEDICARE PTAN (01) | MI |
Q33775 | (02) |