Individual
MRS. ELISE DANIELLE VON HENNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1333 WELLS ST, NILES, MI 49120-1543
(269) 240-3842
Mailing address
1652 PARKVIEW DR, NILES, MI 49120-4547
(269) 240-3842
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202008195
MI
Other
Enumeration date
05/01/2018
Last updated
05/01/2018
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