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General NPI Number Information
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NPI Number | 1851805667
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Entity Type | Organization
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Legal Business Name | SANFORD ABERDEEN MEDICAL CENTER
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Dates
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Enumeration Date | 12/01/2017
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Last Update Date | 12/01/2017
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Provider Practice Location Address
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Address Line | 2905 3RD AVE SE
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City | ABERDEEN
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State | SD
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Zip | 57401-5420
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Country | US
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Telephone | 605-626-4380
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Fax | 605-626-4381
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Provider Business Mailing Address
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Address Line | 2905 3RD AVE SE
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City | ABERDEEN
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State | SD
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Zip | 57401-5420
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Country | US
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Telephone | 605-626-4380
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Fax | 605-626-4381
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Authorized Official
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Title or Position | CERTIFIED OCCUPATIONAL THERAPY ASST
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Name | ABBIE LINNEA HAGEN
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Credential | COTA/L
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Telephone | 605-626-4380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | 362A
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License Number State | SD
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