Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 101521 | MN |
NPI | 1053762955 |
---|---|
Provider Name | Jennifer Alders |
First Address | Maple Grove, MN 55311-4642 |
Second Address | Maple Grove, MN 55311-4642 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2016 |
Last Update Date | 22/06/2016 |