Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 1320 | ND |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 1320 | ND |
NPI | 1083168959 |
---|---|
Provider Name | Jenna Perlichek |
First Address | Minot, ND 58702-5020 |
Second Address | Minot, ND 58701-3880 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2016 |
Last Update Date | 23/10/2017 |