Organization
LISA SANDSTROM LLC
Active
Other names
Still Waters Occupational Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
LISA SANDSTROM (OCCUPATIONAL THERAPIST)
(651) 238-0435
Entity
Organization
Contact information
Practice address
202 GREELEY ST N, STILLWATER, MN 55082-4711
(651) 238-0435
(651) 439-9434
Mailing address
202 GREELEY ST N, STILLWATER, MN 55082-4711
(651) 238-0435
(651) 439-9434
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
103330
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
670000488
MEDICARE PTAN
MN
Enumeration date
01/30/2014
Last updated
01/30/2014
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