Individual
DAVID MARK HENNEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
11612 260TH ST, SAINT CLOUD, MN 56301-9409
(320) 292-7212
Mailing address
11612 260TH ST, SAINT CLOUD, MN 56301-9409
(320) 292-7212
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
104422
MN
225X00000X
Occupational Therapist
11-0104
NV
Other
Enumeration date
04/11/2013
Last updated
04/11/2013
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