Provider Demographics
NPI:1164648259
Name:HENDRICKSON, DARNELL JEAN (OCCUPATIONAL THERAPI)
Entity Type:Individual
Prefix:MRS
First Name:DARNELL
Middle Name:JEAN
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 7TH ST NE
Mailing Address - Street 2:
Mailing Address - City:HINCKLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55037-4702
Mailing Address - Country:US
Mailing Address - Phone:612-578-0689
Mailing Address - Fax:
Practice Address - Street 1:102 7TH ST. N.E.
Practice Address - Street 2:
Practice Address - City:HINCKLEY
Practice Address - State:MN
Practice Address - Zip Code:55037
Practice Address - Country:US
Practice Address - Phone:612-578-0689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100411225X00000X
IA01665225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist