Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 106408 | MN |
NPI | 1003486697 |
---|---|
Provider Name | Elizabeth Warzecha |
First Address | Saint Cloud, MN 56303-5000 |
Second Address | Saint Cloud, MN 56303-5000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2021 |
Last Update Date | 28/06/2021 |