Individual
MRS. AMANDA ELIZABETH NICOLUSSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT, OTR/L
Contact information
Practice address
9357 GENERAL DR, PLYMOUTH, MI 48170-4662
(734) 454-0866
Mailing address
9357 GENERAL DR, PLYMOUTH, MI 48170-4662
(734) 454-0866
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
5201008235
MI
225XP0200X
Pediatric Occupational Therapist
Primary
056.008910
IL
Other
Enumeration date
01/21/2010
Last updated
05/17/2013
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