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General NPI Number Information
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NPI Number | 1225827710
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Entity Type | Organization
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Legal Business Name | IMPACT OCCUPATIONAL THERAPY & CONSULTING
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Dates
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Enumeration Date | 05/02/2025
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 8101 NORMANDALE LAKE BLVD UNIT 205
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City | BLOOMINGTON
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State | MN
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Zip | 55437-4105
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Country | US
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Telephone | 240-535-5258
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Fax |
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Provider Business Mailing Address
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Address Line | 8101 NORMANDALE LAKE BLVD UNIT 205
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City | BLOOMINGTON
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State | MN
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Zip | 55437-4105
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Country | US
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Telephone | 240-535-5258
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NPONDA NADJOMBE
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Credential | OT
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Telephone | 240-535-5258
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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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