Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | ||
Y | 225X00000X | Occupational Therapist | 5302020392 | MI |
NPI | 1003386996 |
---|---|
Provider Name | Nergis Jassim |
First Address | Taylor, MI 48180-4637 |
Second Address | Taylor, MI 48180-4637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2018 |
Last Update Date | 22/04/2021 |