Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 100238 | MN |
NPI | 1306482195 |
---|---|
Provider Name | Michelle Kathleen Ervin |
First Address | Chanhassen, MN 55317-8108 |
Second Address | Golden Valley, MN 55427-4476 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2019 |
Last Update Date | 27/11/2019 |