Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | L144578 | MI |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | L144578 | MI |
NPI | 1053730887 |
---|---|
Provider Name | Mrs. Rachel Cotner Sieferd |
First Address | West Bloomfield, MI 48322-3013 |
Second Address | West Bloomfield, MI 48322-3032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2014 |
Last Update Date | 08/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1629316815 | LIFE SKILLS VILLAGE (01) | MI |