Provider Demographics
NPI:1225827710
Name:IMPACT OCCUPATIONAL THERAPY & CONSULTING
Entity type:Organization
Organization Name:IMPACT OCCUPATIONAL THERAPY & CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NPONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NADJOMBE
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:240-535-5258
Mailing Address - Street 1:8101 NORMANDALE LAKE BLVD UNIT 205
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-4105
Mailing Address - Country:US
Mailing Address - Phone:240-535-5258
Mailing Address - Fax:
Practice Address - Street 1:8101 NORMANDALE LAKE BLVD UNIT 205
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-4105
Practice Address - Country:US
Practice Address - Phone:240-535-5258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty