Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 425645 | MD |
NPI | 1205393691 |
---|---|
Provider Name | Nancy Roseann Poelstra |
First Address | Pinckney, MI 48169-9257 |
Second Address | Dimondale, MI 48821-9744 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2019 |
Last Update Date | 21/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
425645 | AMERICAN OCCUPATIONA THERAPY ASSOCIATION (01) | MD |