Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1053912063 |
---|---|
Provider Name | Caroline Mccleary |
First Address | Saint Paul, MN 55118-4543 |
Second Address | Hudson, WI 54016-8327 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2020 |
Last Update Date | 05/11/2020 |