Individual
ALYCIA TADT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9346 OAK AVE, WACONIA, MN 55387-9422
(952) 223-2506
Mailing address
9346 OAK AVE, WACONIA, MN 55387-9422
(952) 223-2506
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
105586
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
105586
MINNESOTA DEPARTMENT OF HEALTH
MN
Enumeration date
02/20/2018
Last updated
02/25/2022
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