Individual
JEREMY DERHEIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA OTR/L
Contact information
Practice address
2829 VERNDALE AVE, ANOKA, MN 55303
(763) 231-2590
Mailing address
14130 COTTONWOOD BLVD, BECKER, MN 55308
(320) 267-3660
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
105473
MN
Other
Enumeration date
10/05/2017
Last updated
10/05/2017
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