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General NPI Number Information
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NPI Number | 1750626958
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Entity Type | Individual
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Provider Name | MICHELLE MARIE VANDER LINDEN C.O.T.A.
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Gender | Female
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Dates
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Enumeration Date | 11/29/2012
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Last Update Date | 11/29/2012
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Provider Practice Location Address
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Address Line | 2319 7TH ST W
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City | SAINT PAUL
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State | MN
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Zip | 55116-2813
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Country | US
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Telephone | 651-698-0793
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Fax |
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Provider Business Mailing Address
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Address Line | 1613 REDWOOD DR APT 201
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City | HUDSON
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State | WI
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Zip | 54016-9243
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Country | US
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Telephone | 612-242-1603
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 201718
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 4774-027
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License Number State | WI
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