Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XE0001X | Environmental Modification | OT10003 | FL |
Y | 2251E1200X | Ergonomics | OT10003 | FL |
Y | 225XE1200X | Ergonomics | OT10003 | FL |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT10003 | FL |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT10003 | FL |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT10003 | FL |
NPI | 1417907866 |
---|---|
Provider Name | Heather Dibra |
First Address | Minot, ND 58701-6304 |
Second Address | Minot, ND 58701-6304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 23/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
887003900 | (05) | FL |