Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 5201003267 | MI |
NPI | 1639441967 |
---|---|
Provider Name | Mrs. Aimee Fallon |
First Address | Howell, MI 48855-9402 |
Second Address | Howell, MI 48855-9402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2012 |
Last Update Date | 02/02/2012 |