Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 5201000641 | MI |
NPI | 1144713462 |
---|---|
Provider Name | Mrs. Elaine Marie South |
First Address | Plymouth, MI 48170-4610 |
Second Address | Garden City, MI 48135-2319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2018 |
Last Update Date | 25/02/2020 |