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NPI Code Detail

MEDICARE: DEBORAH K PETRON OTRL

MEDICARE: DEBORAH K PETRON OTRL
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 Therapist101473MN

General Provider Information

NPI Number : 1902864572
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH K PETRON OTRL
Provider Business Mailing Address
First Line : 6545 FLYING CLOUD DR STE 201
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-3356
Country : US
Telephone Number : 612-364-1901
Fax Number :
Provider Business Practice Location Address
First Line : 6545 FLYING CLOUD DR STE 201
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-3356
Country : US
Telephone Number : 612-364-1901
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2006
Last Update Date : 08/28/2024

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Directions to “ DEBORAH K PETRON OTRL” Practice Location

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