Basic Information
Provider Information
NPI: 1811092455
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LINDOW
FirstName: ROCHELLE
MiddleName: LAVONNE
NamePrefix:  
NameSuffix:  
Credential: OT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: WILLIAMS
OtherFirstName: ROCHELL
OtherMiddleName: LAVONNE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: OT
OtherLastNameType: 1
Mailing Information
Address1: 4200 DAHLBERG DR
Address2: SUITE 300
City: GOLDEN VALLEY
State: MN
PostalCode: 554224840
CountryCode: US
TelephoneNumber: 9525125600
FaxNumber: 9525125651
Practice Location
Address1: 2855 CAMPUS DR
Address2: SUITE 660
City: PLYMOUTH
State: MN
PostalCode: 554412649
CountryCode: US
TelephoneNumber: 7635207870
FaxNumber: 7635207580
Other Information
ProviderEnumerationDate: 09/14/2006
LastUpdateDate: 09/18/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225XH1200X101067MNY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand

No ID Information.


Home