Individual
MRS. BRYONY FAWNE DEROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
22731 NEWMAN STREET SUITE100B, DEARBORN, MI 48124
(313) 791-0616
Mailing address
22731 NEWMAN SUITE 100B, DEARBORN, MI 48124
(313) 791-0616
Taxonomy
Speciality
Code
Description
License number
State
225XH1200X
Hand Occupational Therapist
Primary
5201005966
MI
Other
Enumeration date
05/29/2007
Last updated
02/19/2008
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