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Individual

MRS. COURTNEY VANDER WAL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
6625 LYNDALE AVE S, RICHFIELD, MN 55423-2373
(952) 285-2840
Mailing address
3246 BALSAM ST SW, PRIOR LAKE, MN 55372-2754

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
107299
MN

Other

Enumeration date
10/03/2023
Last updated
10/03/2023
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