Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 104064 | MN |
N | 225XM0800X | Mental Health | 104064 | MN |
NPI | 1548792021 |
---|---|
Provider Name | Mrs. Clarissa L Mireau |
First Address | Saint Paul, MN 55104-3727 |
Second Address | Saint Paul, MN 55104-3727 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2017 |
Last Update Date | 07/05/2018 |