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General NPI Number Information
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NPI Number | 1447815600
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Entity Type | Individual
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Provider Name | JENNIFER LYNNE ANDERSON OTR/L
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Gender | Female
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Dates
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Enumeration Date | 05/03/2019
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Last Update Date | 05/03/2019
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Provider Practice Location Address
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Address Line | 201 E NICOLLET BLVD
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City | BURNSVILLE
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State | MN
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Zip | 55337-5714
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Country | US
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Telephone | 952-892-2898
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Fax |
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Provider Business Mailing Address
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Address Line | 3850 PRINCETON CIR
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City | EAGAN
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State | MN
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Zip | 55123-1520
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Country | US
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Telephone | 651-323-7055
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 102292
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License Number State | MN
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