Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ||
N | 225XG0600X | Occupational Therapist - Gerontology | ||
N | 225XL0004X | Low Vision | ||
N | 225XM0800X | Mental Health | ||
N | 225XN1300X | Occupational Therapist - Neurorehabilitation |
NPI | 1043453285 |
---|---|
Provider Name | Ms. Christina A Vandezande |
First Address | Marquette, MI 49855-8855 |
Second Address | Marquette, MI 49855-8855 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2009 |
Last Update Date | 03/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5201001027 | LICENSE FOR OCCUPATIONAL THERAPY (01) | MI |
P1657003 | (02) |