Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 104501 | MI |
NPI | 1003087719 |
---|---|
Provider Name | Mrs. Mindy Joy Delacey |
First Address | Duluth, MN 55805-1913 |
Second Address | Duluth, MN 55805-1913 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2008 |
Last Update Date | 22/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
892817700 | (05) | FL |