Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 105556 | MN |
NPI | 1003312695 |
---|---|
Provider Name | Bethany Crystal Skinner |
First Address | Delano, MN 55328-9043 |
Second Address | Buffalo, MN 55313-1934 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2018 |
Last Update Date | 02/04/2018 |