Individual
VICTORIA LYNN FAIRLEY-GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTAL
Contact information
Practice address
17177 N LAUREL PARK DR STE 417, LIVONIA, MI 48152-3952
(734) 666-5995
(877) 414-9925
Mailing address
29221 MARK AVE, MADISON HEIGHTS, MI 48071-4469
(248) 677-4174
(248) 677-4174
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202007270
MI
Other
Enumeration date
05/03/2017
Last updated
05/03/2017
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