Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 106549 | MN |
N | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1720660970 |
---|---|
Provider Name | Kelsey Krob |
First Address | Hermantown, MN 55811-1346 |
Second Address | South Range, WI 54874-8621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2021 |
Last Update Date | 24/05/2021 |