Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | ||
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | MI |
NPI | 1548736457 |
---|---|
Provider Name | Ms. Pamela Outland Cunningham |
First Address | Pleasant Ridge, MI 48069-1104 |
Second Address | Pleasant Ridge, MI 48069-1104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2018 |
Last Update Date | 17/10/2018 |