Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 5201001310 | MI |
NPI | 1255501318 |
---|---|
Provider Name | Mrs. Nancy Anne Fuller |
First Address | Chicago, IL 60606-1216 |
Second Address | Ypsilanti, MI 48197 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2008 |
Last Update Date | 26/11/2008 |