Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 5201006618 | MI |
NPI | 1043657992 |
---|---|
Provider Name | Mrs. Becky Ann Rommel |
First Address | Saint Joseph, MI 49085-1587 |
Second Address | Saint Joseph, MI 49085-1587 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2013 |
Last Update Date | 03/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5201006618 | OCCUPATIONAL THERAPIST LICENSE (01) | MI |