Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 102547 | MN |
NPI | 1073750535 |
---|---|
Provider Name | Mrs. Lori Kay Haag |
First Address | Eden Valley, MN 55329-9261 |
Second Address | Paynesville, MN 56362-1445 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2009 |
Last Update Date | 20/01/2009 |