Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1486 | ND |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT60034778 | WA |
NPI | 1063765402 |
---|---|
Provider Name | Holly Osborn |
First Address | Fargo, ND 58103-6048 |
Second Address | Fargo, ND 58104-8909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2012 |
Last Update Date | 17/05/2019 |