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General NPI Number Information
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NPI Number | 1942279492
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Entity Type | Individual
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Provider Name | TERRI ANN PETERSON OTR, CMLDT
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Gender | Female
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3366 OAKDALE AVE N SUITE 312
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City | ROBBINSDALE
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State | MN
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Zip | 55422-2948
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Country | US
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Telephone | 763-521-3256
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Fax | 763-521-2040
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Provider Business Mailing Address
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Address Line | 8548 EDISON ST NE
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City | BLAINE
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State | MN
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Zip | 55449-5627
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Country | US
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Telephone | 763-717-4941
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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 | 102708
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License Number State | MN
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