Individual
MARY R VANRAVENHORST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
150 ST. ANDREWS COURT, SUITE 310, MANKATO, MN 56001
(507) 388-5437
(507) 388-2108
Mailing address
150 ST. ANDREWS COURT, SUITE 310, MANKATO, MN 56001
(507) 388-5437
(507) 388-2108
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
101743
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15F11VA
BCBS INDIV PROVIDER #
MN
01
—
6411283
MEDICA INDIV PROVIDER #
MN
Enumeration date
01/30/2006
Last updated
04/16/2015
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