Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | 101583 | MN |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 101583 | MN |
N | 225XP0200X | Occupational Therapist - Pediatrics | 101583 | MN |
NPI | 1447515648 |
---|---|
Provider Name | Ms. Susan Jacobs Werner |
First Address | New London, MN 56273-9789 |
Second Address | New London, MN 56273-9789 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2012 |
Last Update Date | 12/07/2012 |