Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201001376 | MI |
NPI | 1245730712 |
---|---|
Provider Name | Shari Wahl |
First Address | Shelby Township, MI 48316-5587 |
Second Address | Livonia, MI 48154-1871 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2018 |
Last Update Date | 20/02/2018 |