Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 002037 | IA |
NPI | 1386951507 |
---|---|
Provider Name | Ms. Maria Michelle Medel |
First Address | Council Bluffs, IA 51503-1911 |
Second Address | Council Bluffs, IA 51503-1911 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2010 |
Last Update Date | 09/09/2010 |