Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5201008292 | MI |
NPI | 1255832432 |
---|---|
Provider Name | Mrs. Samantha Marie Fitzsimmons |
First Address | Canton, MI 48187-1925 |
Second Address | Farmington Hills, MI 48336-1402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2018 |
Last Update Date | 23/02/2018 |