Individual
CAROLYN GRACE PIERCE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
803 ROOSEVELT AVE, SUITE 301, DETROIT LAKES, MN 56501-3744
(218) 844-5555
(218) 844-6057
Mailing address
33656 S COTTON LAKE RD, ROCHERT, MN 56578-9688
(218) 846-2338
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
102049
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005J1PI
BLUECROSSBLUESHIELD-MN
MN
01
—
2109395
FIRST HEALTH
MN
01
—
64-04595
MEDICA HEALTH INS.
MN
01
—
P00086020
RAILROAD MEDICARE
MN
Enumeration date
06/16/2006
Last updated
07/08/2007
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