Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 101383 | MN |
NPI | 1023151339 |
---|---|
Provider Name | Laura Lee Williams |
First Address | Stillwater, MN 55082-4536 |
Second Address | Maplewood, MN 55109-2639 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 08/07/2007 |