Individual
OTIS KEMUTAMBAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
851 PENNIMAN AVE, PLYMOUTH, MI 48170-1621
(248) 349-9595
Mailing address
851 PENNIMAN AVE, PLYMOUTH, MI 48170-1621
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201011022
MI
Other
Enumeration date
10/26/2020
Last updated
10/26/2020
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