Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 104593 | MN |
NPI | 1003262460 |
---|---|
Provider Name | Taylor Peterson |
First Address | Minneapolis, MN 55407-3723 |
Second Address | Minneapolis, MN 55407-3723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2016 |
Last Update Date | 04/05/2016 |