Healthcare Provider Details

I. General information

NPI: 1316257785
Provider Name (Legal Business Name): MICHELLE MARIA ROFKAHR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE MARIA CRIQUI

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 11/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8320 CITY CENTRE DR SUITE G.
WOODBURY MN
55125-3382
US

IV. Provider business mailing address

8320 CITY CENTRE DR SUITE G.
WOODBURY MN
55125-3382
US

V. Phone/Fax

Practice location:
  • Phone: 651-738-9888
  • Fax: 651-738-9889
Mailing address:
  • Phone: 651-738-9888
  • Fax: 651-738-9889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number103911
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: