Individual
GRACE MOORE COLESTOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5855 CHESHIRE PKWY, PLYMOUTH, MN 55446-4005
(763) 744-9400
Mailing address
18040 VALE ST NW, ANDOVER, MN 55304-1418
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
07/24/2023
Last updated
07/24/2023
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