Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 5201000202 | MI |
NPI | 1275924250 |
---|---|
Provider Name | Regina Wilson |
First Address | Farmington Hills, MI 48331-3286 |
Second Address | Ypsilanti, MI 48197-1051 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2015 |
Last Update Date | 23/04/2018 |