Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 707 | ND |
NPI | 1003014499 |
---|---|
Provider Name | Mrs. Heather Ann Thibert |
First Address | Grand Forks, ND 58201 |
Second Address | Grand Forks, ND 58201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2007 |
Last Update Date | 31/12/2018 |