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Individual

JACK SIMONSEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
2029 SOUTHCROSS DR W APT 308, BURNSVILLE, MN 55306-7929
(952) 239-0637
Mailing address
2029 SOUTHCROSS DR W APT 308, BURNSVILLE, MN 55306-7929

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
104750
MN

Other

Enumeration date
09/09/2015
Last updated
09/09/2015
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