Individual
KIMBERLY NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3609 146TH AVE NE, HAM LAKE, MN 55304-6415
(763) 755-3794
Mailing address
3609 146TH AVE NE, HAM LAKE, MN 55304-6415
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
103354
MN
Other
Enumeration date
10/22/2007
Last updated
10/22/2007
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