Individual
AMANDA LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
500 S CHERRY ST, WACONIA, MN 55387-4515
(952) 856-4722
Mailing address
10653 WAYZATA BLVD, MINNETONKA, MN 55305-1528
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
102717
MN
Other
Enumeration date
04/29/2019
Last updated
04/29/2019
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