Individual
STEPHANIE ANN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
550 OSBORNE RD NE, FRIDLEY, MN 55432-2718
(763) 236-3001
Mailing address
3951 CONSTANCE BLVD NE, HAM LAKE, MN 55304-2773
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
103214
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103214
MINNESOTA DEPARTMENT OF HEALTH
MN
Enumeration date
05/16/2007
Last updated
12/13/2018
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