Individual
MRS. CYNTHIA LEANN MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA, MOTR/L
Contact information
Practice address
110 2ND ST S, WAITE PARK, MN 56387-1662
(320) 402-4401
Mailing address
110 2ND ST S, WAITE PARK, MN 56387-1662
(320) 402-4401
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
104887
MN
225X00000X
Occupational Therapist
12363
CA
225X00000X
Occupational Therapist
277541
OR
225X00000X
Occupational Therapist
3127
CO
225X00000X
Occupational Therapist
3707
CT
225X00000X
Occupational Therapist
4686
AZ
Other
Enumeration date
09/20/2010
Last updated
10/19/2023
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