| NPI | 1760501829 |
|---|---|
| Former Name | CHARISE LYNN MCCLURE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MN 103368) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: AZ 3643) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2007-07-24 |