=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396385670
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY ANN MEEHAN MSOT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2020
-----------------------------------------------------
Last Update Date | 01/14/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5232 KYLER AVE NE STE A
-----------------------------------------------------
City | ALBERTVILLE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55301-4634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-223-2506
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 192 SUMMIT AVE
-----------------------------------------------------
City | LORETTO
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55357-2112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-285-8063
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------