Healthcare Provider Details

I. General information

NPI: 1689605875
Provider Name (Legal Business Name): JOLEE KAY HIGGINS O.T.R.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOLEE THOEMKE

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 NORTHWAY DR
SAINT CLOUD MN
56303-4555
US

IV. Provider business mailing address

1555 NORTHWAY DR
SAINT CLOUD MN
56303-4555
US

V. Phone/Fax

Practice location:
  • Phone: 320-259-4100
  • Fax: 320-259-8044
Mailing address:
  • Phone: 320-259-4100
  • Fax: 320-259-8044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number100370
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: