Healthcare Provider Details

I. General information

NPI: 1669319745
Provider Name (Legal Business Name): ELIZABETH GARLOUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 W 106TH ST
BLOOMINGTON MN
55431-4152
US

IV. Provider business mailing address

14932 DUNDEE AVE
APPLE VALLEY MN
55124-7771
US

V. Phone/Fax

Practice location:
  • Phone: 616-822-9361
  • Fax:
Mailing address:
  • Phone: 616-822-9361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number104622
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: