Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201003901 | MI |
NPI | 1003183054 |
---|---|
Provider Name | Traci Hammis |
First Address | Saginaw, MI 48603-2699 |
Second Address | Saginaw, MI 48603-2699 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2011 |
Last Update Date | 18/11/2011 |