Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 106565 | MN |
NPI | 1023687043 |
---|---|
Provider Name | Megan Elizabeth Rosauer Gray |
First Address | Lino Lakes, MN 55014-1192 |
Second Address | Lino Lakes, MN 55014-1192 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2021 |
Last Update Date | 23/06/2021 |