Individual
CARISSA MAE THELEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
701 W FRONT ST, TRAVERSE CITY, MI 49684-2287
(231) 935-0800
Mailing address
10670 E PICO DR, TRAVERSE CITY, MI 49684-5382
(906) 241-3521
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201013761
MI
Other
Enumeration date
05/11/2021
Last updated
08/29/2024
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