Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 201706 | MN |
NPI | 1013290311 |
---|---|
Provider Name | Ms. Stephanie Joann Powers |
First Address | St Louis Park, MN 55416-4854 |
Second Address | St Louis Park, MN 55416-4854 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2011 |
Last Update Date | 22/09/2011 |