Individual
LEANN MARIE SHORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTD, MA, OTR/L
Contact information
Practice address
7432 PARK AVE, RICHFIELD, MN 55423-4462
(952) 237-5398
Mailing address
PO BOX 23511, RICHFIELD, MN 55423-0511
(952) 237-5398
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
101975
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005572
NBCOT
MN
01
—
101975
MN LICENSE
MN
Enumeration date
06/28/2013
Last updated
06/28/2013
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