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NPI Code Detail

MEDICARE: CASSIDY ERICKSEN

MEDICARE: CASSIDY ERICKSEN
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
1224Z00000XOccupational Therapy Assistant202015MN

General Provider Information

NPI Number : 1376076562
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASSIDY ERICKSEN
Provider Business Mailing Address
First Line : 1670 LEGACY PKWY E
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55109-5469
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1670 LEGACY PKWY E
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55109-5469
Country : US
Telephone Number : 952-697-0627
Fax Number : 479-201-2084
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2017
Last Update Date : 04/05/2017

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Directions to “ CASSIDY ERICKSEN ” Practice Location

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