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NPI Code Detail

MEDICARE: LYNN MARIE QUAM OTR/L

MEDICARE:   LYNN MARIE QUAM  OTR/L
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
1225X00000XOccupational Therapist103915MN

General Provider Information

NPI Number : 1194383661
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNN MARIE QUAM OTR/L
Provider Business Mailing Address
First Line : 10405 SHELTER GRV
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55347-4858
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7615 GOLDEN TRIANGLE DR STE A
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-3733
Country : US
Telephone Number : 952-767-5914
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2019
Last Update Date : 08/13/2021

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Directions to “ LYNN MARIE QUAM OTR/L” Practice Location

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