Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 18159 | CA |
NPI | 1144973397 |
---|---|
Provider Name | Kelly Ann Holden |
First Address | Plymouth, MN 55441-3001 |
Second Address | Plymouth, MN 55441-3001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2022 |
Last Update Date | 28/01/2022 |