MEDICARE: JOELLE ALSTAD

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	104965	MN

General Provider Information

NPI Number	:	1992171920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOELLE ALSTAD

Provider Business Mailing Address
First Line	:	4922 TYLER ST NE
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-1927
Country	:	US
Telephone Number	:	651-238-8745
Fax Number	:

Provider Business Practice Location Address
First Line	:	4922 TYLER ST NE
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-1927
Country	:	US
Telephone Number	:	651-238-8745
Fax Number	:

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

Provider Enumeration Date	:	08/13/2015
Last Update Date	:	08/13/2015

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Directions to “ JOELLE ALSTAD ” Practice Location

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