Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 103530 | MN |
NPI | 1063965507 |
---|---|
Provider Name | Amy Carleton |
First Address | Victoria, MN 55386-0034 |
Second Address | Savage, MN 55378-2561 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2016 |
Last Update Date | 10/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001442700 | (05) | MN |
1311578 | ARAZ/AMERICA'S PPO/CIGNA (01) | MN |
16154051 | PT CARE (01) | MN |
169036 | UCARE (01) | MN |
565581028803 | PREFERRED ONE (01) | MN |
76842 | HEALTH PARTNERS (01) | MN |
78B64KI | BCBS (01) | MN |