Provider Demographics
NPI:1174730899
Name:ADVANCE OCCUPATIONAL THERAPY, LLC
Entity type:Organization
Organization Name:ADVANCE OCCUPATIONAL THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CORBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:651-784-7007
Mailing Address - Street 1:6776 LAKE DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LINO LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-1156
Mailing Address - Country:US
Mailing Address - Phone:651-784-7007
Mailing Address - Fax:651-784-7992
Practice Address - Street 1:6776 LAKE DR
Practice Address - Street 2:SUITE 220
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55014-1156
Practice Address - Country:US
Practice Address - Phone:651-784-7007
Practice Address - Fax:651-784-7992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
MN102776225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty