| NPI | 1467880971 |
|---|---|
| Former Name | AMANDA ELIZABETH THEISEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MI 5201008628) |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics (Licence: MI 5201008628) |
| Enumeration Date | 2013-10-18 |
| Last Update Date | 2018-09-12 |