Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 104692 | MN |
NPI | 1154722346 |
---|---|
Provider Name | Kimberly Lynn Mcclintick |
First Address | Golden Valley, MN 55422-4841 |
Second Address | Edina, MN 55435-1706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2014 |
Last Update Date | 23/04/2018 |