Basic Information
| Provider Information | |||||||||
| NPI: | 1629523097 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ANDERSON | ||||||||
| FirstName: | MICHELE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 FERGUS AVE | ||||||||
| Address2: | |||||||||
| City: | HENNING | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565514034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669910900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 CROSS ST | ||||||||
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| City: | BIG STONE CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 572168237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6055411140 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2016 | ||||||||
| LastUpdateDate: | 04/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 083893 | IA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 101150 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.