Provider Demographics
NPI:1871955609
Name:ANDERSON, JAMIE MARIE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:MARIE
Other - Last Name:GARNTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3700 FOSS RD
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-4512
Mailing Address - Country:US
Mailing Address - Phone:612-913-5317
Mailing Address - Fax:612-788-0104
Practice Address - Street 1:3700 FOSS RD
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55421-4512
Practice Address - Country:US
Practice Address - Phone:612-913-5317
Practice Address - Fax:612-788-0104
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104606225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist