Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 5201000053 | MI |
NPI | 1023590189 |
---|---|
Provider Name | Ms. Pam Sue Krum |
First Address | Niles, MI 49120-4797 |
Second Address | Niles, MI 49120-4797 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2018 |
Last Update Date | 05/09/2018 |