Individual
MS. MARY ALICIA PATILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3964 17TH ST, ECORSE, MI 48229-1310
(313) 467-7000
Mailing address
3964 17TH ST, ECORSE, MI 48229-1310
(313) 467-7000
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202004214
MI
Other
Enumeration date
01/17/2012
Last updated
01/17/2012
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