Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 100147 | MN |
NPI | 1003079641 |
---|---|
Provider Name | Ms. Audrey Marie Chaput |
First Address | Mahtomedi, MN 55115-2808 |
Second Address | Mahtomedi, MN 55115-2808 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2008 |
Last Update Date | 05/03/2012 |