Provider Demographics
NPI:1740592898
Name:JUAREZ, DENISE MARIE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:MARIE
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7236 RIVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-1320
Mailing Address - Country:US
Mailing Address - Phone:214-282-9202
Mailing Address - Fax:763-503-3596
Practice Address - Street 1:7236 RIVERDALE RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-1320
Practice Address - Country:US
Practice Address - Phone:214-282-9202
Practice Address - Fax:763-503-3596
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103526225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist