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NPI Code Detail

MEDICARE: ALLI JEAN FOX OTR/L

MEDICARE: ALLI JEAN FOX 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
1103K00000XBehavior Analyst
2225X00000XOccupational Therapist106081MN

General Provider Information

NPI Number : 1740830371
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLI JEAN FOX OTR/L
Provider Business Mailing Address
First Line : 4265 BEAVER DAM RD
Second Line :
City : EAGAN
State : MN
Zip : 55122-2222
Country : US
Telephone Number : 612-709-9102
Fax Number :
Provider Business Practice Location Address
First Line : 2060 CENTRE POINTE BLVD STE 3
Second Line :
City : MENDOTA HEIGHTS
State : MN
Zip : 55120-1271
Country : US
Telephone Number : 866-822-7464
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2019
Last Update Date : 12/08/2020

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