Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 201829 | MN |
NPI | 1003250861 |
---|---|
Provider Name | Linda Jeanne Mix Yates |
First Address | St Louis Park, MN 55426-3011 |
Second Address | St Louis Park, MN 55426-3011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2013 |
Last Update Date | 24/04/2013 |