Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 5201001581 | MI |
NPI | 1093284473 |
---|---|
Provider Name | Therese Ann Foote |
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 | 15/11/2018 |
Last Update Date | 15/11/2018 |