Individual
MS. WENDY JOAN MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
213 1ST AVE SE, AITKIN, MN 56431-1711
(218) 839-1792
Mailing address
213 1ST AVE SE, AITKIN, MN 56431-1711
(218) 839-1792
Taxonomy
Speciality
Code
Description
License number
State
225XP0019X
Physical Rehabilitation Occupational Therapist
Primary
101530
MN
Other
Enumeration date
10/09/2009
Last updated
10/09/2009
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