Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5201006437 | MI |
NPI | 1053623348 |
---|---|
Provider Name | Scott Alan Truskowski |
First Address | Grand Rapids, MI 49506-4336 |
Second Address | Grand Rapids, MI 49506-4336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2010 |
Last Update Date | 02/07/2010 |