Organization
ROOTS TO WINGS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JO ANNE TIERNEY OTR/L (OCCUPATIONAL THERAPIST, LICENSED)
(651) 206-1034
Entity
Organization
Contact information
Practice address
2354 FIELD STONE CT, MENDOTA HEIGHTS, MN 55120-1917
(651) 206-1034
Mailing address
2354 FIELD STONE CT, MENDOTA HEIGHTS, MN 55120-1917
(651) 206-1034
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
102635
MN
Other
Enumeration date
11/27/2011
Last updated
11/27/2011
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