Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 100707 | MN |
NPI | 1194831743 |
---|---|
Provider Name | Susan E Anderson |
First Address | Woodbury, MN 55125-4925 |
Second Address | Edina, MN 55435-1706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 21/11/2017 |