Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201009169 | MI |
NPI | 1003304601 |
---|---|
Provider Name | Mrs. Kelsey Danielle Nichols |
First Address | Kalamazoo, MI 49048-1666 |
Second Address | Kalamazoo, MI 49048-1666 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2018 |
Last Update Date | 29/04/2018 |