Provider Demographics
NPI:1770307860
Name:UNGLESBEE, JEANNE MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:MARIE
Last Name:UNGLESBEE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:MARIE
Other - Last Name:GORAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8488 CASEY CT
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-5154
Mailing Address - Country:US
Mailing Address - Phone:651-338-5890
Mailing Address - Fax:
Practice Address - Street 1:825 MOUNT CURVE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-3035
Practice Address - Country:US
Practice Address - Phone:651-631-6570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102940225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist