Individual
AUDREY THELEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
731 STARKWEATHER DR, LANSING, MI 48917-1128
(517) 323-9133
Mailing address
1041 W MAIN ST, GRAND LEDGE, MI 48837-1007
(517) 449-6872
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202007426
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5202007426
MICHIGAN OCCUPATIONAL THERAPY ASSISTANT LICENSE
MI
Enumeration date
11/14/2013
Last updated
11/14/2013
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