Individual
ANDREA LIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
701 PARK AVE, MINNEAPOLIS, MN 55415-1623
(612) 873-4748
Mailing address
2412 GIRARD AVE S, APT 1, MINNEAPOLIS, MN 55405-2535
(715) 575-5671
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5505-26
WI
Other
Enumeration date
06/13/2014
Last updated
12/11/2016
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