Basic Information
| Provider Information | |||||||||
| NPI: | 1316491970 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEZAR | ||||||||
| FirstName: | ANGELA | ||||||||
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| Address1: | 814 RIVER LN | ||||||||
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| City: | ANOKA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553032807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635670219 | ||||||||
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| Practice Location | |||||||||
| Address1: | 435 PHALEN BLVD | ||||||||
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| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551305302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512543200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2016 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 105115 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.