Healthcare Provider Details

I. General information

NPI: 1407792062
Provider Name (Legal Business Name): MARIAH LOISELLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDUCATIONAL SERVICES CENTER 1350 W. 106TH ST.
BLOOMINGTON MN
55431
US

IV. Provider business mailing address

5531 WASHBURN AVE S APT 11
MINNEAPOLIS MN
55410-2409
US

V. Phone/Fax

Practice location:
  • Phone: 952-681-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: