Individual
LINDA KAY FAIRCHILD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
100400
MN
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
810345-1-WS
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
172360800
—
MN
01
—
218986-4-AFC
ADULT FOSTER CARE
MN
01
—
810345-1-WS
HOME AND COMMUNITY BASED
MN
Enumeration date
07/06/2006
Last updated
12/28/2017
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