Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 101119 | MN |
NPI | 1154887685 |
---|---|
Provider Name | Mrs. Danetta Lavell |
First Address | Saint Paul, MN 55103-2101 |
Second Address | Saint Paul, MN 55103-2101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2019 |
Last Update Date | 20/02/2019 |