Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201006195 | MI |
NPI | 1225518731 |
---|---|
Provider Name | Mrs. Debra M Burkholder |
First Address | Glenview, IL 60026-8001 |
Second Address | Montague, MI 49437-9264 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2018 |
Last Update Date | 15/08/2018 |