Individual
NELSON CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
1100 E MICHIGAN AVE, GRAYLING, MI 49738-1312
(989) 348-0314
Mailing address
607 DEWEY AVE NW STE 300, GRAND RAPIDS, MI 49504-7335
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201005985
MI
Other
Enumeration date
12/06/2018
Last updated
12/06/2018
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