Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 103981 | MN |
NPI | 1013975663 |
---|---|
Provider Name | Ms. Renee Haroldson |
First Address | Maple Grove, MN 55369-4730 |
Second Address | Maple Grove, MN 55369-4730 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 02/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
192940 | BCBS OCCUPATIONAL THERAPY (01) | VA |
670001766 | RAILROAD MEDICARE (01) | VA |
7601113 | AETNA (01) | |
8937141 | (05) | VA |