Individual
YIA LOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3130 GRIMES AVE N, ROBBINSDALE, MN 55422-3217
(651) 434-8107
Mailing address
1965 IVY AVE E, SAINT PAUL, MN 55119-3224
(651) 434-8107
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
106109
MN
Other
Enumeration date
03/07/2021
Last updated
03/07/2021
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