Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 105839 | MN |
NPI | 1285282681 |
---|---|
Provider Name | Mrs. Margaret Bao Van Kor |
First Address | Annandale, MN 55302-3060 |
Second Address | Annandale, MN 55302-3060 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2019 |
Last Update Date | 28/08/2019 |