Individual
MARY RUST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.T
Contact information
Practice address
81 W KRAFT RD, WEST SAINT PAUL, MN 55118-3816
(651) 600-9826
Mailing address
81 W KRAFT RD, WEST SAINT PAUL, MN 55118-3816
(651) 600-9826
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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