Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | L1352297 | MI |
NPI | 1003177114 |
---|---|
Provider Name | Theresa A Stanley |
First Address | Bad Axe, MI 48413-9712 |
Second Address | Bad Axe, MI 48413-9712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2012 |
Last Update Date | 05/06/2012 |