Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225200000X | Physical Therapy Assistant | 5502001938 | MI |
Y | 225X00000X | Occupational Therapist | 5201009263 | MI |
NPI | 1013351121 |
---|---|
Provider Name | Mrs. Ada Ladelle Gallant |
First Address | Howell, MI 48855-7266 |
Second Address | West Bloomfield, MI 48322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2013 |
Last Update Date | 23/08/2018 |