Individual
TATIANA IVEZAJ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTAL
Contact information
Practice address
175 FRANKLIN LAKE CIR, OXFORD, MI 48371-3665
(248) 602-9132
Mailing address
175 FRANKLIN LAKE CIR, OXFORD, MI 48371-3665
(248) 602-9132
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202008425
MI
Other
Enumeration date
06/30/2021
Last updated
06/30/2021
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