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General NPI Number Information
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NPI Number | 1760501829
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Entity Type | Individual
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Provider Name | CHARISE VAN MAASDAM OTR,L
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Gender | Female
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 07/24/2007
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Provider Practice Location Address
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Address Line | 2450 RIVERSIDE AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55454-1450
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Country | US
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Telephone | 612-273-6507
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Fax |
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Provider Business Mailing Address
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Address Line | 4129 TOLEDO AVE S
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City | SAINT LOUIS PARK
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State | MN
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Zip | 55416-3206
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Country | US
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Telephone |
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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 | 103368
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 3643
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License Number State | AZ
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