Individual
LEAH TISDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2450 RIVERSIDE AVE, MINNEAPOLIS, MN 55454-1450
(612) 365-6777
Mailing address
2544 CHRISTIAN PKWY, CHASKA, MN 55318-1986
(952) 769-6441
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
105939
MN
Other
Enumeration date
01/18/2019
Last updated
03/20/2019
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