Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist |
NPI | 1003416934 |
---|---|
Provider Name | Jane Shekleton |
First Address | Spearfish, SD 57783-3252 |
Second Address | Minot, ND 58701-6781 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2020 |
Last Update Date | 29/10/2020 |