Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1352 | ND |
NPI | 1003222878 |
---|---|
Provider Name | Leslie Anne Myer |
First Address | Fargo, ND 58108-6001 |
Second Address | Fargo, ND 58103-6132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2014 |
Last Update Date | 23/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1460507 | (05) | ND |