Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201003359 | MI |
NPI | 1003023466 |
---|---|
Provider Name | Mr. Vijay Mishra |
First Address | Troy, MI 48085-3261 |
Second Address | Troy, MI 48085-3261 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 03/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OP10490 | (02) | MI |