Provider Demographics
NPI:1821329889
Name:FERNELIUS, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:FERNELIUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 XERXES AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-2851
Mailing Address - Country:US
Mailing Address - Phone:612-721-5551
Mailing Address - Fax:612-721-3290
Practice Address - Street 1:1501 XERXES AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-2851
Practice Address - Country:US
Practice Address - Phone:612-721-5551
Practice Address - Fax:612-721-3290
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100154225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics