Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 104767 | MN |
NPI | 1033507421 |
---|---|
Provider Name | Melanie Deutsch |
First Address | Maple Grove, MN 55311-4516 |
Second Address | Otsego, MN 55330-9452 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2015 |
Last Update Date | 07/01/2015 |