Provider Demographics
NPI:1477506715
Name:THRALOW, JOAN (OT)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:THRALOW
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 W SAINT GERMAIN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4743
Mailing Address - Country:US
Mailing Address - Phone:320-259-4151
Mailing Address - Fax:320-259-5707
Practice Address - Street 1:2835 W SAINT GERMAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4743
Practice Address - Country:US
Practice Address - Phone:320-259-4151
Practice Address - Fax:320-259-5707
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN100395225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP36163OtherHEALTHPARTNERS ID
MN6403645OtherMEDICA PROVIDER ID
MN012L6THOtherBCBS INDIVIDUAL ID