Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 105953 | MN |
N | 225X00000X | Occupational Therapist | 1134 | SD |
NPI | 1003574567 |
---|---|
Provider Name | Ashley Dwire |
First Address | Big Stone City, SD 57216-8237 |
Second Address | Minneota, MN 56264-9237 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2021 |
Last Update Date | 02/12/2021 |