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General NPI Number Information
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NPI Number | 1366201626
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Entity Type | Individual
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Provider Name | JOANNA NICOLE ANDERSON OTR/L
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Gender | Female
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Dates
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Enumeration Date | 03/18/2024
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Last Update Date | 03/18/2024
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Provider Practice Location Address
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Address Line | 1861 COMMERCE BLVD
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City | MOUND
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State | MN
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Zip | 55364-1293
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Country | US
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Telephone | 952-240-3285
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Fax |
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Provider Business Mailing Address
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Address Line | 4786 CARRICK RD
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City | MOUND
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State | MN
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Zip | 55364-1873
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Country | US
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Telephone | 612-601-6197
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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 | 106436
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License Number State | MN
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