Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5201007356 | MI |
NPI | 1982042586 |
---|---|
Provider Name | Mrs. Angela Dawn West |
First Address | Waterford, MI 48329-2430 |
Second Address | Troy, MI 48083-1110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2013 |
Last Update Date | 05/06/2013 |