Individual
CODY LINK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
1705 ANNE ST NW, BEMIDJI, MN 56601-6151
(218) 333-4887
(218) 333-4783
Mailing address
1705 ANNE ST NW, BEMIDJI, MN 56601-6151
(218) 333-4887
(218) 333-4783
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1644
NE
Other
Enumeration date
02/09/2016
Last updated
02/09/2016
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