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Individual

ALYSSA ENGDAHL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
5655 W 35TH ST, ST LOUIS PARK, MN 55416-2460
(612) 432-4091
Mailing address
5655 WEST 35TH STREET, ST. LOUIS PARK, MN 55416
(612) 432-4091

Taxonomy

Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
104949
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
104949
OT LICENSE
MN
Enumeration date
11/20/2015
Last updated
11/20/2015
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