Individual
MR. KASEY EHREN MIKLIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
2660 LAKE SHORE AVE, LITTLE CANADA, MN 55117-1320
(612) 978-8393
Mailing address
2660 LAKE SHORE AVE, LITTLE CANADA, MN 55117-1320
(612) 978-8393
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
105007
MN
174400000X
Specialist
Primary
9926
NC
174400000X
Specialist
OT01543
RI
Other
Enumeration date
06/27/2016
Last updated
06/27/2016
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