Individual
MR. AL DG MANDEOYA GRANDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTRL
Contact information
Practice address
2333 BIDDLE AVE, WYANDOTTE, MI 48192
(734) 246-7732
Mailing address
28053 WEDDEL AVE, BROWNSTOWN TWP, MI 48183-4841
(734) 341-5391
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201008599
MI
Other
Enumeration date
09/06/2012
Last updated
06/27/2018
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