Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 248 | ND |
NPI | 1003963042 |
---|---|
Provider Name | Mrs. Mary Dusek |
First Address | Grafton, ND 58237-1379 |
Second Address | Grafton, ND 58237-1379 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
59444 | (05) | ND |