Individual
VICKY GAIL TANANA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
29800 HOOVER RD, WARREN, MI 48093-3483
(586) 574-3444
Mailing address
715 FIELDSTONE DR, ROCHESTER HILLS, MI 48309-1633
(248) 568-8915
Taxonomy
Speciality
Code
Description
License number
State
225XG0600X
Gerontology Occupational Therapist
Primary
5201002288
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5201002288
—
MI
Enumeration date
04/12/2018
Last updated
04/12/2018
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