Basic Information
| Provider Information | |||||||||
| NPI: | 1720370992 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZIMMERMANN | ||||||||
| FirstName: | CASSANDRA | ||||||||
| MiddleName: | JANE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.A., OTR/L | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SWENSON | ||||||||
| OtherFirstName: | CASSANDRA | ||||||||
| OtherMiddleName: | JANE | ||||||||
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| OtherCredential: | M.A., OTR/L | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6590 MACKENZIE AVE NE | ||||||||
| Address2: | |||||||||
| City: | OTSEGO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553014615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6127918120 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2829 VERNDALE AVE | ||||||||
| Address2: | |||||||||
| City: | ANOKA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553031620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7632312590 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2011 | ||||||||
| LastUpdateDate: | 05/06/2011 | ||||||||
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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 | 225XP0200X | 104031 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.