Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 104259 | MN |
Y | 225X00000X | Occupational Therapist | 1278 | ND |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 104259 | MN |
NPI | 1134482599 |
---|---|
Provider Name | Amanda Jean Vingelen |
First Address | Grand Forks, ND 58201 |
Second Address | Grand Forks, ND 58201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2012 |
Last Update Date | 26/06/2018 |