Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 100403 | MN |
NPI | 1356468953 |
---|---|
Provider Name | Ms. Kelly Margaret Flanagan |
First Address | Prior Lake, MN 55372 |
Second Address | Minneapolis, MN 55407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 08/07/2007 |