Individual
JENNY MAE KATLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
7900 W 28TH ST, ST LOUIS PARK, MN 55426-3011
(952) 920-8380
(952) 920-7866
Mailing address
7900 W 28TH ST, ST LOUIS PARK, MN 55426-3011
(952) 920-8380
(952) 920-7866
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
200995
MN
Other
Enumeration date
03/17/2008
Last updated
03/17/2008
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