Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251P0200X | Physical Therapist - Pediatrics | MI | |
N | 225X00000X | Occupational Therapist | 5201008308 | MI |
N | 225XF0002X | Feeding, Eating & Swallowing | 5201008308 | MI |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5201008308 | MI |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201008308 | MI |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 5201008308 | MI |
NPI | 1093103020 |
---|---|
Provider Name | Mrs. Maria Margaret Dobbertien |
First Address | Battle Creek, MI 49017 |
Second Address | Battle Creek, MI 49015-2097 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2014 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1578951380 | (05) | MI |