Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5201004061 | MI |
NPI | 1255875050 |
---|---|
Provider Name | Ms. Phyllis Scott |
First Address | Caro, MI 48723-9319 |
Second Address | Caro, MI 48723-9319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2016 |
Last Update Date | 13/12/2016 |