Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 201275 | MN |
NPI | 1013016088 |
---|---|
Provider Name | Amy L Golla |
First Address | Woodbury, MN 55125-3382 |
Second Address | Woodbury, MN 55125-3382 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 08/07/2007 |