Individual
MRS. GABRIELLE RENATE LIGHTCAP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTAL
Contact information
Practice address
3508 S LAPEER RD, METAMORA, MI 48455-8768
(810) 212-1134
Mailing address
3508 S LAPEER RD, METAMORA, MI 48455-8768
(810) 212-1134
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202008546
MI
Other
Enumeration date
10/14/2019
Last updated
10/14/2019
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