Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 5201006059 | MI |
NPI | 1720558935 |
---|---|
Provider Name | Mrs. Nicole P Martin |
First Address | Flint, MI 48506-3149 |
Second Address | Flint, MI 48506-3149 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2018 |
Last Update Date | 30/11/2018 |