Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 3038 | MN |
NPI | 1073952693 |
---|---|
Provider Name | Ms. Katie Jean Ohm |
First Address | Minneapolis, MN 55413-1951 |
Second Address | Plymouth, MN 55441-2307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2013 |
Last Update Date | 17/06/2013 |