Individual
KATHERINE HAILEY LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1835 COUNTY ROAD C W, ROSEVILLE, MN 55113-1352
(651) 638-0080
(651) 638-0020
Mailing address
1835 COUNTY ROAD C W, ROSEVILLE, MN 55113-1352
(651) 638-0080
(651) 638-0082
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
107723
MN
Other
Enumeration date
09/21/2020
Last updated
03/17/2025
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