Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5201005512 | MI |
NPI | 1295975613 |
---|---|
Provider Name | Mrs. Danielle Lynn Knickerbocker |
First Address | East Lansing, MI 48823 |
Second Address | East Lansing, MI 48823-7755 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2009 |
Last Update Date | 25/02/2009 |