| NPI | 1760648661 |
|---|---|
| Former Name | DEANNA RAE BONGARD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: WI 5304-26) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MN 103489) |
| Enumeration Date | 2008-07-31 |
| Last Update Date | 2017-04-26 |