Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | 00001513 | WA |
Y | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1043554181 |
---|---|
Provider Name | Mrs. Michelle Lyn Nelson |
First Address | Burbank, WA 99323-9717 |
Second Address | Burbank, WA 99323-9717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2012 |
Last Update Date | 26/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00001513 | (05) | WA |