Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 103162 | MN |
NPI | 1114104544 |
---|---|
Provider Name | Robert Edward Roed |
First Address | Cass Lake, MN 56633-3428 |
Second Address | Cass Lake, MN 56633-3428 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2008 |
Last Update Date | 29/01/2008 |