Basic Information
| Provider Information | |||||||||
| NPI: | 1811154982 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BREWER | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | SUZANNE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MOTR | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | IONADI | ||||||||
| OtherFirstName: | LISA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3201 SPRUCE ST | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486406445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894861128 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 449 QUARTER ST | ||||||||
| Address2: | |||||||||
| City: | GLADWIN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486241918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894263430 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2008 | ||||||||
| LastUpdateDate: | 05/16/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.