Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 103344 | MN |
NPI | 1942633060 |
---|---|
Provider Name | Anna Lea Bromeland |
First Address | Shakopee, MN 55379-2248 |
Second Address | Shakopee, MN 55379-2248 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2013 |
Last Update Date | 12/08/2013 |