Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 1374 | ND |
NPI | 1063817914 |
---|---|
Provider Name | Kassandra Engeberg |
First Address | Bismarck, ND 58503-1226 |
Second Address | Bismarck, ND 58503-1226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2014 |
Last Update Date | 21/04/2021 |