Individual
SARA I HUSBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
815 FOREST AVE, NORTHFIELD, MN 55057-1643
(507) 664-8800
Mailing address
1920 ROOSEVELT DR APT 54, NORTHFIELD, MN 55057-3512
(218) 396-0351
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
201299
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201299
—
MN
Enumeration date
07/16/2009
Last updated
07/16/2009
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