Individual
NICOLE ELAINE MOLD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1891 STATION PKWY NW, ANDOVER, MN 55304-4259
(763) 755-4275
Mailing address
4344 230TH AVE NW, SAINT FRANCIS, MN 55070-9504
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
103477
MN
Other
Enumeration date
06/22/2010
Last updated
06/22/2010
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