Individual
TRACI FRIEDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
14635 PENNOCK AVE, SUITE #300, APPLE VALLEY, MN 55124-6430
(952) 997-2823
(952) 997-6931
Mailing address
4058 DEERWOOD TRL, EAGAN, MN 55122-1889
(651) 994-9644
(651) 994-8962
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
103493
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8D301FR
BCBS
MN
Enumeration date
09/12/2007
Last updated
09/12/2007
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