MEDICARE: DAWN ROSS

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	102666	MN

General Provider Information

NPI Number	:	1508264540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN ROSS

Provider Business Mailing Address
First Line	:	4201 EXCELSIOR BLVD
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-4728
Country	:	US
Telephone Number	:	952-933-8900
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 EXCELSIOR BLVD
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-4728
Country	:	US
Telephone Number	:	952-933-8900
Fax Number	:

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

Provider Enumeration Date	:	12/08/2014
Last Update Date	:	12/08/2014

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Directions to “ DAWN ROSS ” Practice Location

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