Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5201004716 | MI |
NPI | 1083835573 |
---|---|
Provider Name | Mr. Robert Clarence Ferguson |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 08/07/2007 |