Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1003182569 |
---|---|
Provider Name | Amy M Mcclellan |
First Address | Duluth, MN 55806-3526 |
Second Address | Duluth, MN 55806-3526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2012 |
Last Update Date | 29/03/2012 |