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Individual

MARY RUST

Active
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Individual

MARY RUST

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
O.T

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
100577
MN
171W00000X
Contractor
OT 60446052
WA
171W00000X
Contractor
OTR2691
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100577
OCCUPATIONAL THERAPY LICENSE
MN
01
—
OT 60446052
OCCUPATIONAL THERAPY LICENSE
WA
01
—
OTR2691
OCCUPATIONAL THERAPY LICENSE
AR
Enumeration date
04/05/2014
Last updated
04/05/2014
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