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General NPI Number Information
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NPI Number | 1508340480
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Entity Type | Individual
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Provider Name | SHOSHANA RUBIN OT
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Gender | Female
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Dates
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Enumeration Date | 09/18/2018
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Last Update Date | 09/18/2018
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Provider Practice Location Address
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Address Line | 11140 HIGHWAY 55
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City | PLYMOUTH
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State | MN
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Zip | 55441-6016
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Country | US
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Telephone | 763-595-0812
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Fax |
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Provider Business Mailing Address
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Address Line | 2631 QUENTIN AVE
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-1958
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Country | US
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Telephone | 612-432-8226
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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 | 105183
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License Number State | MN
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