Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5201005842 | MI |
NPI | 1164861563 |
---|---|
Provider Name | Ms. Holly Lynn Koroleski |
First Address | Midland, MI 48640-4449 |
Second Address | Midland, MI 48640-4449 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2013 |
Last Update Date | 19/06/2013 |