Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 105317 | MN |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 105317 | MN |
NPI | 1144767500 |
---|---|
Provider Name | Kristin Barstad |
First Address | Saint Paul, MN 55116-2741 |
Second Address | Edina, MN 55435-4305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2017 |
Last Update Date | 24/01/2017 |