Individual
SHAWNA LANGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
15620 EDGEWOOD DR STE 240, BAXTER, MN 56401-6984
(218) 454-7012
(218) 454-7015
Mailing address
500 CROSS ST, BIG STONE CITY, SD 57216-8237
(605) 541-1140
(605) 541-0109
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
102274
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
246567
MEDICARE
MN
05
—
683227000
—
MN
Enumeration date
11/08/2007
Last updated
07/01/2022
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