Healthcare Provider Details

I. General information

NPI: 1982933685
Provider Name (Legal Business Name): KRISTINE DOOLEY OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6936 GARLAND LN N
MAPLE GROVE MN
55311-4642
US

IV. Provider business mailing address

6936 GARLAND LN N
MAPLE GROVE MN
55311-4642
US

V. Phone/Fax

Practice location:
  • Phone: 763-416-9313
  • Fax: 763-416-4530
Mailing address:
  • Phone: 763-416-9313
  • Fax: 763-416-4530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: