Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5201001712 | MI |
NPI | 1538358668 |
---|---|
Provider Name | Vickie M. Green |
First Address | Warren, MI 48088-6683 |
Second Address | Warren, MI 48088-6683 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2007 |
Last Update Date | 15/10/2007 |