Individual
MISS DANA BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7727 PORTLAND AVE, RICHFIELD, MN 55423-4320
(612) 455-0304
(612) 861-0186
Mailing address
7727 PORTLAND AVE, RICHFIELD, MN 55423-4320
(612) 455-0304
(612) 861-0186
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
201944
MN
Other
Enumeration date
07/15/2014
Last updated
07/15/2014
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