Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201002229 | MI |
N | 225XE0001X | Environmental Modification | 5201002229 | MI |
N | 225XF0002X | Feeding, Eating & Swallowing | 5201002229 | MI |
N | 225XM0800X | Mental Health | 5201002229 | MI |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5201002229 | MI |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201002229 | MI |
N | 225XP0200X | Occupational Therapist - Pediatrics | 5201002229 | MI |
NPI | 1841685161 |
---|---|
Provider Name | Mrs. Debra Marie Willing-Tucker |
First Address | Linden, MI 48451-8427 |
Second Address | Linden, MI 48451-8427 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2015 |
Last Update Date | 02/04/2015 |