Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5201008391 | MI |
NPI | 1417201369 |
---|---|
Provider Name | Zachary S Smith |
First Address | South Boardman, MI 49680-9762 |
Second Address | Traverse City, MI 49686-3456 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2012 |
Last Update Date | 21/10/2019 |