Basic Information
| Provider Information | |||||||||
| NPI: | 1184043879 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLEISCHMAN | ||||||||
| FirstName: | BETHANY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7400 OAK PARK VILLAGE DR | ||||||||
| Address2: | #6 | ||||||||
| City: | SAINT LOUIS PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554264195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152160333 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7900 W 28TH ST | ||||||||
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| City: | SAINT LOUIS PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554263011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529208380 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2014 | ||||||||
| LastUpdateDate: | 04/10/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 104649 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.