Organization
TWIN CITIES OCCUPATIONAL HEALTH AND REHABILITATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANICE K RAVERTY (CLINIC ADMINISTRATOR)
(651) 224-8264
Entity
Organization
Contact information
Practice address
10190 BALTIMORE STREET NORTH EAST, SUITE 100, BLAINE, MN 55449
(763) 780-8264
(763) 780-8274
Mailing address
10190 BALTIMORE STREET NORTH EAST, SUITE 100, BLAINE, MN 55449
(763) 780-8264
(763) 780-8274
Taxonomy
Speciality
Code
Description
License number
State
261QX0100X
Occupational Medicine Clinic/Center
Primary
30816
MN
261QX0100X
Occupational Medicine Clinic/Center
42667
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30816
MEDICAL LICENSE
MN
01
—
42667
MEDICAL LICENSE
MN
Enumeration date
07/02/2007
Last updated
10/20/2010
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