Individual
MRS. MARY JO THEIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
300 COON RAPIDS BLVD NW, COON RAPIDS, MN 55433-5643
(763) 767-0854
Mailing address
12912 VAN BUREN ST NE, BLAINE, MN 55434-3258
(763) 754-2346
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
200265
MN
Other
Enumeration date
04/12/2007
Last updated
07/08/2007
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