Individual
MIA ROSE MASSARO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2555 COUNTY ROAD E E, WHITE BEAR LAKE, MN 55110-4906
(651) 683-2953
Mailing address
6776 LAKE DR STE 220, LINO LAKES, MN 55014-1192
(651) 784-7007
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
6028
MN
Other
Enumeration date
05/31/2019
Last updated
09/26/2023
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