Individual
ALICIA MALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
4949 COOLIDGE HWY, ROYAL OAK, MI 48073-1026
(248) 655-5660
Mailing address
102 SLATESTONE DR, SAGINAW, MI 48603-3577
(989) 780-4984
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201009649
MI
Other
Enumeration date
04/11/2018
Last updated
04/11/2018
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