Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 106424 | MN |
NPI | 1063002608 |
---|---|
Provider Name | Paige Marie Nelles |
First Address | Saint Michael, MN 55376-9363 |
Second Address | Hutchinson, MN 55350-5685 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2021 |
Last Update Date | 18/01/2021 |