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NPI Code Detail

MEDICARE: EMMA MARIE FULLERTON GRUND

MEDICARE: EMMA MARIE FULLERTON GRUND
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 Therapist105538MN

General Provider Information

NPI Number : 1720935240
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMMA MARIE FULLERTON GRUND
Provider Business Mailing Address
First Line : 15708 N LUND RD
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55346-1549
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5605 GREEN CIRCLE DR
Second Line :
City : MINNETONKA
State : MN
Zip : 55343-4523
Country : US
Telephone Number : 612-217-0436
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2026
Last Update Date : 03/13/2026

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Directions to “ EMMA MARIE FULLERTON GRUND ” Practice Location

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