Provider Demographics
NPI:1154448306
Name:MISSELHORN, TWYLA MARIE (CTRS)
Entity Type:Individual
Prefix:MS
First Name:TWYLA
Middle Name:MARIE
Last Name:MISSELHORN
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4243 QUEEN AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-1543
Mailing Address - Country:US
Mailing Address - Phone:612-522-0362
Mailing Address - Fax:763-520-4179
Practice Address - Street 1:4243 QUEEN AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-1543
Practice Address - Country:US
Practice Address - Phone:612-522-0362
Practice Address - Fax:763-520-4179
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist