Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1003392911 |
---|---|
Provider Name | Gail Beck |
First Address | Tyler, MN 56178-1154 |
Second Address | Tyler, MN 56178-1201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2018 |
Last Update Date | 13/07/2018 |