Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003160979 |
---|---|
Provider Name | Mr. Randy Lee Denooyer |
First Address | Wyoming, MI 49509-2738 |
Second Address | Wyoming, MI 49509-2738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2012 |
Last Update Date | 31/10/2012 |