Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 1036735 | MI |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201005348 | MI |
NPI | 1063918357 |
---|---|
Provider Name | Mrs. Shelly L Budnik |
First Address | Alpena, MI 49707-1434 |
Second Address | Alpena, MI 49707-1434 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2018 |
Last Update Date | 10/01/2022 |