Healthcare Provider Details

I. General information

NPI: 1588798623
Provider Name (Legal Business Name): ALLINA HOSPITALS AND CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 DORMAN AVE
MINNEAPOLIS MN
55406-1836
US

IV. Provider business mailing address

2830 DORMAN AVE
MINNEAPOLIS MN
55406-1836
US

V. Phone/Fax

Practice location:
  • Phone: 612-722-3059
  • Fax:
Mailing address:
  • Phone: 612-722-3059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number101325
License Number StateMN

VIII. Authorized Official

Name: CAROL J PELTIER
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR
Phone: 612-722-3059