Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT558 | ID |
N | 225XH1200X | Occupational Therapist - Hand | 1020367 | MD |
NPI | 1255321246 |
---|---|
Provider Name | Michelle L Bjornson |
First Address | Nampa, ID 83686-6811 |
Second Address | Nampa, ID 83687-9203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2005 |
Last Update Date | 09/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000010150172 | BLUE SHIELD (01) | ID |
P00218129 | RAILROAD MEDICARE (01) | ID |
W1028 | BLUE CROSS (01) | ID |