Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201006900 | MI |
NPI | 1003287202 |
---|---|
Provider Name | Tiffany Keith |
First Address | Adrian, MI 49221-1463 |
Second Address | Adrian, MI 49221-1463 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2015 |
Last Update Date | 13/10/2015 |