Individual
MRS. STACEY MARIE DESOUZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
360 SHERMAN ST, 470, SAINT PAUL, MN 55102-2564
(651) 209-6520
(651) 209-6521
Mailing address
360 SHERMAN ST STE 470, SAINT PAUL, MN 55102-2988
(651) 209-6520
(651) 209-6521
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
102928
MN
Other
Enumeration date
06/04/2013
Last updated
06/04/2013
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