Provider Demographics
NPI:1477721736
Name:GRABAU, ANGIE LYNN
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:LYNN
Last Name:GRABAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:LYNN
Other - Last Name:GRABAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 COBBLESTONE LN
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4578
Mailing Address - Country:US
Mailing Address - Phone:952-898-5700
Mailing Address - Fax:952-898-5757
Practice Address - Street 1:100 COBBLESTONE LN
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4578
Practice Address - Country:US
Practice Address - Phone:952-898-5700
Practice Address - Fax:952-898-5757
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103020225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist