Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 102368 | MN |
NPI | 1104053198 |
---|---|
Provider Name | Allison V Mikota |
First Address | Woodbury, MN 55125-4925 |
Second Address | Eagan, MN 55123-1188 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2009 |
Last Update Date | 02/07/2015 |