Provider Demographics
NPI:1801412366
Name:KOOPMEINERS, TAYLOR ANN
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ANN
Last Name:KOOPMEINERS
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 1:298 BROOKS ST N
Mailing Address - Street 2:
Mailing Address - City:EDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55329-1209
Mailing Address - Country:US
Mailing Address - Phone:320-453-2990
Mailing Address - Fax:320-453-2900
Practice Address - Street 1:298 BROOKS ST N
Practice Address - Street 2:
Practice Address - City:EDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55329-1209
Practice Address - Country:US
Practice Address - Phone:320-453-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-21
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MN6092225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician