Organization
JENNIFER MANNING
Active
Other names
Lake Region Therapy Services
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER MICHELLE MANNING OTRL (OWNER OCCUPATIONAL THERAPIST)
(218) 844-5555
Entity
Organization
Contact information
Practice address
803 ROOSEVELT AVE, SUITE 301, DETROIT LAKES, MN 56501
(218) 844-5555
(218) 844-6057
Mailing address
803 ROOSEVELT AVE, SUITE 301, DETROIT LAKES, MN 56501
(218) 844-5555
(218) 844-6057
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
8826097
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
053D8LA
BLUE COSS BLUE SHIELD
MN
Enumeration date
06/09/2006
Last updated
10/17/2007
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