Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5201003401 | MI |
NPI | 1649418393 |
---|---|
Provider Name | Mr. Michael Patrick O'connor |
First Address | Mason, MI 48854-0111 |
Second Address | Lansing, MI 48906-5334 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2009 |
Last Update Date | 06/04/2016 |