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General NPI Number Information
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NPI Number | 1861701872
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Entity Type | Individual
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Provider Name | KENDRA DARWIN O.T.
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Gender | Female
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Dates
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Enumeration Date | 09/26/2010
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Last Update Date | 09/26/2010
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Provider Practice Location Address
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Address Line | 3525 MONTEREY DR
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City | SAINT LOUIS PARK
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State | MN
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Zip | 55416-5275
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Country | US
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Telephone | 952-993-3620
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Fax |
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Provider Business Mailing Address
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Address Line | 3308 GRAND AVE S APT 4
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-3982
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Country | US
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Telephone | 612-203-9550
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 103964
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License Number State | MN
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