Individual
MARIA HENNEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
5033 ROSE CREEK PKWY S, FARGO, ND 58104-6848
(763) 689-5385
Mailing address
5033 ROSE CREEK PKWY S, FARGO, ND 58104-6848
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
100794
MN
225X00000X
Occupational Therapist
Primary
365
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15166
BCBS
ND
01
—
5G717MA
BCBS
MN
01
—
6411124
MEDICA
MN
Enumeration date
09/27/2006
Last updated
07/09/2007
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