Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1700362381 |
---|---|
Provider Name | Rachel Roxanne Hayman |
First Address | Fort Gratiot, MI 48059-2817 |
Second Address | Fort Gratiot, MI 48059-2817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2018 |
Last Update Date | 17/07/2018 |