Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201002140 | MI |
NPI | 1285164558 |
---|---|
Provider Name | Mrs. Lisa Marie Lutes I |
First Address | Saint Clair Shores, MI 48081-3125 |
Second Address | Sterling Heights, MI 48314-3891 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2017 |
Last Update Date | 19/06/2017 |