Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 5201000631 | MI |
NPI | 1124097639 |
---|---|
Provider Name | Mrs. Elaine P Larson |
First Address | Grand Rapids, MI 49525-6406 |
Second Address | Grand Rapids, MI 49525-6406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 10/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0P4770008 | (02) | MI |