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Individual

MRS. JANA LYNN FOSSUM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OTR L

Contact information

Practice address
1891 STATION PKWY NW, ANDOVER, MN 55304-4259
(763) 755-4275
(763) 755-4261
Mailing address
17740 71ST AVE N, MAPLE GROVE, MN 55311-4012
(612) 386-7131

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
102082
MN

Other

Enumeration date
09/27/2006
Last updated
04/27/2010
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