Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 5201001218 | MI |
NPI | 1639594948 |
---|---|
Provider Name | Tina Beyerlein |
First Address | Reese, MI 48757-9704 |
Second Address | Reese, MI 48757-9704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2014 |
Last Update Date | 24/02/2014 |