Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 105133 | MN |
NPI | 1023471406 |
---|---|
Provider Name | Sara Elizabeth Sieberg |
First Address | Mankato, MN 56001-1120 |
Second Address | Mankato, MN 56001-8805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2016 |
Last Update Date | 04/04/2018 |