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General NPI Number Information
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NPI Number | 1992749162
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Entity Type | Individual
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Provider Name | DIANE ANDERSON O.T.
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Gender | Female
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 200 OAK STREET S.E. MCNAMARA ALUMNI CENTER SUITE 160 UNIVERSITY OF MINNESOTA PHYSICIANS
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City | MINNEAPOLIS
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State | MN
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Zip | 55455
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Country | US
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Telephone | 612-626-5645
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Fax |
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Provider Business Mailing Address
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Address Line | 420 DELAWARE STREET SE MMC 388 UNIVERSITY OF MINNESOTA PHYSICIANS
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City | MINNEAPOLIS
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State | MN
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Zip | 55455
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Country | US
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Telephone | 612-625-2661
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Fax | 612-624-6686
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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 | 101023
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License Number State | MN
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