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General NPI Number Information
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NPI Number | 1780152520
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Entity Type | Individual
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Provider Name | KIMBERLY TAFARO
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Gender | Female
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Dates
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Enumeration Date | 11/09/2018
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Last Update Date | 11/09/2018
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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 | 15865 GRIFFON PATH
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City | APPLE VALLEY
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State | MN
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Zip | 55124-6662
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Country | US
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Telephone | 608-630-7853
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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 | 105782
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License Number State | MN
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