MEDICARE: JENNIFER MARIE FRISON 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
1	225XP0200X	Pediatric Occupational Therapist	103720	MN

General Provider Information

NPI Number	:	1578875142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARIE FRISON OTR/L

Provider Business Mailing Address
First Line	:	6776 LAKE DR STE 220
Second Line	:
City	:	LINO LAKES
State	:	MN
Zip	:	55014-1192
Country	:	US
Telephone Number	:	651-784-7007
Fax Number	:	651-784-7992

Provider Business Practice Location Address
First Line	:	2555 COUNTY ROAD E E
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55110-4906
Country	:	US
Telephone Number	:	651-683-2953
Fax Number	:

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

Provider Enumeration Date	:	07/11/2010
Last Update Date	:	12/21/2018

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