Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0496 | SD |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 0496 | SD |
NPI | 1154672707 |
---|---|
Provider Name | Lori Dubisar |
First Address | Sioux Falls, SD 57104-4647 |
Second Address | Sioux Falls, SD 57104-4647 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2012 |
Last Update Date | 23/09/2012 |