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General NPI Number Information
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NPI Number | 1093922403
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Entity Type | Organization
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Legal Business Name | BODY AND SOUL THERAPY
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7200 FRANCE AVE S SUITE 227
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City | EDINA
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State | MN
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Zip | 55435-4300
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Country | US
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Telephone | 952-830-4615
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Fax |
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Provider Business Mailing Address
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Address Line | 7200 FRANCE AVE S SUITE 227
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City | EDINA
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State | MN
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Zip | 55435-4300
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Country | US
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Telephone | 952-830-4615
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. JAMIE LYNN WYTTENBACH
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Credential | OTR
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Telephone | 952-830-4615
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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 | 102921
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License Number State | MN
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