Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 100336 | MN |
NPI | 1154426856 |
---|---|
Provider Name | Bonnie Lynn Shelley |
First Address | Golden Valley, MN 55422-4841 |
Second Address | Edina, MN 55435-1706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 09/06/2021 |