Individual
LISA KAY MITTENESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L, BCBA
Contact information
Practice address
1018 MADISSON ST, ALEXANDRIA, MN 56308-4897
(320) 760-4061
Mailing address
1018 MADISSON ST, ALEXANDRIA, MN 56308-4897
(320) 760-4061
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1153
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
55932
—
ND
Enumeration date
01/05/2012
Last updated
01/20/2019
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