Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 5201007684 |
NPI | 1790254266 |
---|---|
Provider Name | Sonny Kay Grendel |
First Address | Ann Arbor, MI 48105-9335 |
Second Address | Ann Arbor, MI 48105-9335 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2018 |
Last Update Date | 14/11/2018 |