Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201007137 | MI |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation |
NPI | 1578909271 |
---|---|
Provider Name | Mrs. Andrea Marie-Gimbosa Childers |
First Address | Troy, MI 48084-2684 |
Second Address | Troy, MI 48083-1110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2013 |
Last Update Date | 21/05/2013 |