1669631636 NPI number — MS. CHARLANE MARTHA STRAND OCCUPATIONAL THERAPI

Table of content: MS. CHARLANE MARTHA STRAND OCCUPATIONAL THERAPI (NPI 1669631636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669631636 NPI number — MS. CHARLANE MARTHA STRAND OCCUPATIONAL THERAPI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STRAND
Provider First Name:
CHARLANE
Provider Middle Name:
MARTHA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OCCUPATIONAL THERAPI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MINOR
Provider Other First Name:
CHARLANE
Provider Other Middle Name:
MARTHA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICENSE OTR
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669631636
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10725 JAMES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMINGTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55431-4137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-884-5859
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 SMITH AVE N
Provider Second Line Business Practice Location Address:
UNITED HOSPITAL
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55102-2344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-241-8565
Provider Business Practice Location Address Fax Number:
651-241-7117
Provider Enumeration Date:
06/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  100584 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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