Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 104723 | MN |
NPI | 1215325360 |
---|---|
Provider Name | Kathleen Thomason |
First Address | Belle Plaine, MN 56011-1224 |
Second Address | Plymouth, MN 55441-2307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2014 |
Last Update Date | 23/12/2014 |