Individual
MRS. MARY ROSE NORDLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR, CHT
Contact information
Practice address
8100 NORTHLAND DR, BLOOMINGTON, MN 55431-4800
(952) 831-8742
Mailing address
7600 W 84TH ST, BLOOMINGTON, MN 55438-1304
(952) 941-0228
Taxonomy
Speciality
Code
Description
License number
State
225XH1200X
Hand Occupational Therapist
Primary
100337
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100337
STATE OT LICENSE
MN
Enumeration date
03/03/2006
Last updated
01/18/2019
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