Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 105938 | MN |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 105938 | MN |
NPI | 1114586419 |
---|---|
Provider Name | Eric John Sorensen |
First Address | Woodbury, MN 55129-2253 |
Second Address | Minneapolis, MN 55407-3723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2019 |
Last Update Date | 09/02/2020 |