Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 5201008522 | MI |
NPI | 1053880237 |
---|---|
Provider Name | Mrs. Kristen Nicole Bourns |
First Address | Canton, MI 48187-3533 |
Second Address | Canton, MI 48187-3533 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2018 |
Last Update Date | 18/11/2018 |