Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 103043 | MN |
NPI | 1417194176 |
---|---|
Provider Name | Mrs. Kathryn Ann Flanagan |
First Address | Plainview, MN 55964-1041 |
Second Address | Plainview, MN 55964-1041 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2009 |
Last Update Date | 16/01/2009 |