Individual
TINA PAULK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15104 LAC LAVON DR, BURNSVILLE, MN 55306-6368
(952) 686-3561
Mailing address
15104 LAC LAVON DR, BURNSVILLE, MN 55306-6368
(952) 686-3561
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
106722
MN
Other
Enumeration date
04/17/2026
Last updated
04/17/2026
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