Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 5201003135 | MI |
NPI | 1245660125 |
---|---|
Provider Name | Nykie Moyer |
First Address | Lansing, MI 48917-1128 |
Second Address | Lansing, MI 48917-1128 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2013 |
Last Update Date | 14/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5201003135 | OCCUPATIONAL THERAPY LICENSE (01) | MI |