Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 0951 | SD |
N | 225XP0200X | Occupational Therapist - Pediatrics | 0951 | SD |
NPI | 1275912511 |
---|---|
Provider Name | Nikki Soulek |
First Address | Mitchell, SD 57301-7284 |
Second Address | Mitchell, SD 57301-7284 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2015 |
Last Update Date | 27/03/2020 |