Basic Information
| Provider Information | |||||||||
| NPI: | 1457484917 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCGEE | ||||||||
| FirstName: | COREY | ||||||||
| MiddleName: | WESTON | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MS, OTRL, CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8861 JAMES AVE S | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554312060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528813353 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6363 FRANCE AVE. SOUTH | ||||||||
| Address2: | SUITE 404 | ||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529274525 | ||||||||
| FaxNumber: | 9529277554 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | 103360 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
No ID Information.