Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 100058 | MN |
NPI | 1023130416 |
---|---|
Provider Name | Ms. Sandra Marie Meyer |
First Address | Eagan, MN 55121-1915 |
Second Address | Bloomington, MN 55431-4420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100058 | STATE LICENSURE NUMBER (01) | MN |
270793 | NATIONAL REGISTRATION NUM (01) |