Healthcare Provider Details

I. General information

NPI: 1285282681
Provider Name (Legal Business Name): MARGARET BAO VAN KOR OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARGARET BAO VAN NGUYEN OTR/L

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 11/09/2024
Certification Date: 11/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 W 81ST ST STE 112
BLOOMINGTON MN
55437-1111
US

IV. Provider business mailing address

4801 W 81ST ST STE 112
BLOOMINGTON MN
55437-1111
US

V. Phone/Fax

Practice location:
  • Phone: 952-913-2907
  • Fax: 952-345-6789
Mailing address:
  • Phone: 952-913-2907
  • Fax: 952-345-6789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number105839
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number105839
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: