Provider Demographics
NPI:1952550246
Name:ANDERSON, CINDY (OT)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 SUNSET CT
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-3255
Mailing Address - Country:US
Mailing Address - Phone:507-301-3141
Mailing Address - Fax:
Practice Address - Street 1:1961 CARDINAL LN STE A
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-4354
Practice Address - Country:US
Practice Address - Phone:507-333-2986
Practice Address - Fax:507-333-2918
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103447225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist