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General NPI Number Information
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NPI Number | 1104624550
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Entity Type | Individual
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Provider Name | LAURA JEAN DICKASON-SOPETH OTR
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Gender | Female
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 8758 EGAN DR
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City | SAVAGE
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State | MN
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Zip | 55378-2561
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Country | US
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Telephone | 952-473-9888
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Fax |
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Provider Business Mailing Address
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Address Line | 17420 IXONIA CT
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City | LAKEVILLE
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State | MN
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Zip | 55044-8741
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Country | US
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Telephone | 612-280-3514
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 100665
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License Number State | MN
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