Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 102346 | MN |
NPI | 1396130548 |
---|---|
Provider Name | Kathleen White |
First Address | Rochester, MN 55901-3733 |
Second Address | Rochester, MN 55901-3733 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2015 |
Last Update Date | 04/04/2015 |