Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 104224 | MN |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 924 | ND |
NPI | 1366703613 |
---|---|
Provider Name | Susan Ann Schneider |
First Address | Fargo, ND 58104-4394 |
Second Address | Fargo, ND 58104-4394 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2012 |
Last Update Date | 04/06/2012 |