Provider Demographics
NPI:1801930482
Name:STINE, JANET WORK (OTRL)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:WORK
Last Name:STINE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2814 KELLER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109
Mailing Address - Country:US
Mailing Address - Phone:651-332-1737
Mailing Address - Fax:
Practice Address - Street 1:2495 MAPLEWOOD DRIVE
Practice Address - Street 2:SUITE 313
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1913
Practice Address - Country:US
Practice Address - Phone:651-770-8884
Practice Address - Fax:651-770-8151
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN100823225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics