Healthcare Provider Details

I. General information

NPI: 1669570909
Provider Name (Legal Business Name): MARY KATHLEEN LAGORIO OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6363 FRANCE AVE S #100
EDINA MN
55435-2129
US

IV. Provider business mailing address

6024 N RIDGE DR
SAVAGE MN
55378-3609
US

V. Phone/Fax

Practice location:
  • Phone: 952-920-8525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number101733
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: