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Individual

CAROLYNN BETH DECKER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
6120 STADIUM DR, KALAMAZOO, MI 49009-3022
(800) 379-1600
Mailing address
3522 TAMSIN AVE, KALAMAZOO, MI 49008-2019

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
5201006454
MI
225X00000X
Occupational Therapist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1977
MI
05
225X00000X
MI
Enumeration date
12/27/2018
Last updated
12/27/2018
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