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NPI Code Detail

MEDICARE: KRYSTLE DESIREE PLOHOCKY MA, OTR/L

MEDICARE: KRYSTLE DESIREE PLOHOCKY MA, OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist103819MN

General Provider Information

NPI Number : 1902641798
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRYSTLE DESIREE PLOHOCKY MA, OTR/L
Provider Business Mailing Address
First Line : 1660 HIGHWAY 100 S STE 103
Second Line :
City : SAINT LOUIS PARK
State : MN
Zip : 55416-1599
Country : US
Telephone Number : 763-531-5039
Fax Number : 763-531-5004
Provider Business Practice Location Address
First Line : 9751 REGENT AVE N
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55443-1402
Country : US
Telephone Number : 763-315-5340
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2024
Last Update Date : 06/25/2024

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