Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 105637 | MN |
NPI | 1043791056 |
---|---|
Provider Name | Emily Gutfleisch |
First Address | Duluth, MN 55812-3729 |
Second Address | Duluth, MN 55804-2243 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2018 |
Last Update Date | 27/08/2018 |