Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 201989 | MN |
NPI | 1053795963 |
---|---|
Provider Name | Amber Small |
First Address | Woodbury, MN 55125-2433 |
Second Address | Inver Grove Heights, MN 55076-2521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2015 |
Last Update Date | 10/07/2015 |