Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 102753 | MN |
NPI | 1295219681 |
---|---|
Provider Name | Keri Walczak |
First Address | Lakeville, MN 55044-7299 |
Second Address | Lakeville, MN 55044-7299 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2018 |
Last Update Date | 20/09/2018 |