| NPI | 1831343979 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MN 103668) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: KS 24-00476) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MN 2136) | |
| Enumeration Date | 2008-11-14 |
| Last Update Date | 2020-05-20 |