MEDICARE: KAY IRENE JAMES OTR/L, CLT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	101134	MN

General Provider Information

NPI Number	:	1093155962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAY IRENE JAMES OTR/L, CLT

Provider Business Mailing Address
First Line	:	805 6TH AVE NW
Second Line	:
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-2717
Country	:	US
Telephone Number	:	763-228-3014
Fax Number	:

Provider Business Practice Location Address
First Line	:	805 6TH AVE NW
Second Line	:
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-2717
Country	:	US
Telephone Number	:	657-403-5247
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2013
Last Update Date	:	06/25/2013

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