Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ||
N | 225XH1200X | Occupational Therapist - Hand |
NPI | 1043679657 |
---|---|
Provider Name | Katie Welle |
First Address | Sauk Centre, MN 56378-8416 |
Second Address | Lynden, WA 98264-1539 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2016 |
Last Update Date | 11/02/2016 |