Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 105095 | MN |
NPI | 1194187021 |
---|---|
Provider Name | Molly Kaitlin Bohil |
First Address | Duluth, MN 55812-1150 |
Second Address | Duluth, MN 55805-1950 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2016 |
Last Update Date | 28/09/2016 |