Provider Demographics
NPI:1124158753
Name:ZARIMBA, LANCE DAVID (OT)
Entity type:Individual
Prefix:MR
First Name:LANCE
Middle Name:DAVID
Last Name:ZARIMBA
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 UPTON AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-1948
Mailing Address - Country:US
Mailing Address - Phone:612-623-1195
Mailing Address - Fax:
Practice Address - Street 1:2014 NORTHDALE BLVD
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433
Practice Address - Country:US
Practice Address - Phone:763-755-5495
Practice Address - Fax:763-754-7077
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103204225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist