Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 5821 | MN |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 106491 | MN |
NPI | 1225622772 |
---|---|
Provider Name | Eryn Anne Lewis |
First Address | Fargo, ND 58103-4940 |
Second Address | Duluth, MN 55805-1950 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2021 |
Last Update Date | 19/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
106491 | MN BOARD OF OCCUPATIONAL THERAPY (01) | MN |
1225622772 | NPI (01) | MN |