Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | ||
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 392 | ND |
NPI | 1255749024 |
---|---|
Provider Name | Bryce Nelson |
First Address | Fargo, ND 58102-2931 |
Second Address | Fargo, ND 58102-2931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2014 |
Last Update Date | 10/09/2014 |