Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | ND670 | ND |
NPI | 1891739074 |
---|---|
Provider Name | Karen Gayton |
First Address | Bismarck, ND 58501-3942 |
Second Address | Bismarck, ND 58501-3942 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 07/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
22614 | BCBS (01) | ND |
P83480 | (02) | ND |