Individual
MIRANDA MASSEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
14130 23RD AVE N, PLYMOUTH, MN 55447
(763) 383-7666
(763) 383-6013
Mailing address
14130 23RD AVE N, PLYMOUTH, MN 55447
(763) 383-7666
(763) 383-6013
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
107151
MN
225XP0200X
Pediatric Occupational Therapist
107151
MN
Other
Enumeration date
04/14/2023
Last updated
12/06/2023
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