Individual
CARISA DEE TACKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
101 S HILL ST, LA CRESCENT, MN 55947-1389
(507) 895-4445
Mailing address
435 S 1ST ST, LA CRESCENT, MN 55947-1323
(715) 965-4685
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
202463
MN
224Z00000X
Occupational Therapy Assistant
Primary
563247
WI
Other
Enumeration date
09/03/2021
Last updated
09/26/2023
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