Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 5201007153 | MI |
NPI | 1033401757 |
---|---|
Provider Name | Mrs. Kimberly Jo Valencia |
First Address | Bay City, MI 48706-3626 |
Second Address | Kennett Square, PA 19348-3109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2011 |
Last Update Date | 13/05/2011 |