Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5201009102 | MI |
NPI | 1417386608 |
---|---|
Provider Name | Sarah Bouali |
First Address | Clinton Township, MI 48038-1656 |
Second Address | Clinton Township, MI 48038-1656 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2013 |
Last Update Date | 29/06/2015 |