Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 100438 | MN |
NPI | 1033455498 |
---|---|
Provider Name | Mary O'shaughnessy Smith |
First Address | Woodbury, MN 55125-4925 |
Second Address | Vadnais Heights, MN 55127-7135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2012 |
Last Update Date | 02/07/2015 |