Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist |
NPI | 1003374604 |
---|---|
Provider Name | Ariana Lyn Pelkey |
First Address | Saint Paul, MN 55104-6183 |
Second Address | Robbinsdale, MN 55422-2207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2019 |
Last Update Date | 04/03/2019 |