Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ||
N | 225XG0600X | Occupational Therapist - Gerontology | 5201011428 | MI |
NPI | 1255097432 |
---|---|
Provider Name | Sara Alyse Asmar |
First Address | Glenview, IL 60026-8001 |
Second Address | Troy, MI 48085-1117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2021 |
Last Update Date | 27/12/2021 |