Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 105264 | MN |
NPI | 1760018923 |
---|---|
Provider Name | Hanna Annette Stevenson |
First Address | Halstad, MN 56548-4125 |
Second Address | Ada, MN 56510-1279 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2020 |
Last Update Date | 19/03/2020 |