Individual
MARY LOU WITTMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
323 S MINNESOTA ST, CROOKSTON, MN 56716-1601
(218) 281-9462
(218) 281-9336
Mailing address
323 S MINNESOTA ST, CROOKSTON, MN 56716-1601
(218) 281-9462
(218) 281-9336
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
102843
MN
225X00000X
Occupational Therapist
Primary
533
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
410724029
TAX ID#
—
Enumeration date
07/20/2012
Last updated
07/20/2012
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