Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5201007237 | MI |
NPI | 1114330263 |
---|---|
Provider Name | Ursula Kotzabassi |
First Address | Romulus, MI 48174-1383 |
Second Address | Romulus, MI 48174-1383 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2014 |
Last Update Date | 06/06/2014 |