Individual
STEPHANIE L BLOSSOMGAME
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
20600 S. DIAMOND LAKE RD, ROGERS, MN 55374
(763) 428-4315
Mailing address
20600 S. DIAMOND LAKE RD, ROGERS, MN 55374
(763) 428-4315
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
103651
MN
Other
Enumeration date
04/29/2024
Last updated
12/30/2024
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