1790145647 NPI number — MISS MARY KATHLEEN SALVESON OCCUPATIONAL THERAPI

Table of content: MISS MARY KATHLEEN SALVESON OCCUPATIONAL THERAPI (NPI 1790145647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790145647 NPI number — MISS MARY KATHLEEN SALVESON OCCUPATIONAL THERAPI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALVESON
Provider First Name:
MARY
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
MISS
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790145647
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
THERAPY JUNCTION 14130 23RD AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-383-7666
Provider Business Mailing Address Fax Number:
763-383-6013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
THERAPY JUNCTION 14130 23RD AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-383-7666
Provider Business Practice Location Address Fax Number:
763-383-6013
Provider Enumeration Date:
03/03/2016

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:  1456 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: 105288 , 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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