Individual
ALYSSA NOEL BAGNALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MOT
Contact information
Practice address
2370 STILLWATER AVE E APT 303, MAPLEWOOD, MN 55119-3680
(641) 208-7033
Mailing address
2370 STILLWATER AVE E APT 303, MAPLEWOOD, MN 55119-3680
(641) 208-7033
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
104554
MN
Other
Enumeration date
09/24/2013
Last updated
09/24/2013
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