Healthcare Provider Details

I. General information

NPI: 1073693511
Provider Name (Legal Business Name): AMBER VREEMAN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 11/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10557 W RIVER RD
BROOKLYN PARK MN
55443-1231
US

IV. Provider business mailing address

10557 W RIVER RD
BROOKLYN PARK MN
55443-1231
US

V. Phone/Fax

Practice location:
  • Phone: 612-743-0350
  • Fax:
Mailing address:
  • Phone: 612-743-0350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number102318
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: