Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 106700 | MN |
NPI | 1033874672 |
---|---|
Provider Name | Kelly Greeninger |
First Address | Woodbury, MN 55125-4925 |
Second Address | Plymouth, MN 55446-3399 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2021 |
Last Update Date | 08/11/2021 |