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General NPI Number Information
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NPI Number | 1083320063
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Entity Type | Organization
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Legal Business Name | EIKO MIZUSHIMA INTEGRATIVE OT LLC
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Dates
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Enumeration Date | 01/24/2023
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 3528 14TH AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-2223
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Country | US
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Telephone | 608-577-1385
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Fax |
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Provider Business Mailing Address
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Address Line | 3528 14TH AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-2223
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EIKO MIZUSHIMA
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Credential | OTR/L
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Telephone | 608-577-1385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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