Organization
INNOVATIVE THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY JO DANIELSON MAOTR/L (OWNER/OCCUPATIONAL THERAPIST)
(612) 597-2975
Entity
Organization
Contact information
Practice address
5480 NATHAN LN N STE 140, PLYMOUTH, MN 55442-1995
(612) 597-2975
Mailing address
1696 7TH ST NW, BUFFALO, MN 55313-5050
(612) 597-2975
(763) 682-1668
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128152600
—
MN
01
—
183942
U-CARE
MN
Enumeration date
07/10/2006
Last updated
12/19/2017
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