Individual
MRS. STACEY ANN ETHERTON-AGIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
261 MACK AVE, DETROIT, MI 48201-2417
(313) 745-0982
Mailing address
1789 BROADSTONE RD, GROSSE POINTE WOODS, MI 48236-1950
(313) 212-9722
Taxonomy
Speciality
Code
Description
License number
State
225XP0019X
Physical Rehabilitation Occupational Therapist
Primary
5201001866
MI
Other
Enumeration date
06/12/2018
Last updated
06/16/2018
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