MEDICARE: KRISTEN LEE OECHSLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1073165098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN LEE OECHSLE

Provider Business Mailing Address
First Line	:	220 E MAIN ST STE 1
Second Line	:
City	:	MANKATO
State	:	MN
Zip	:	56001-3574
Country	:	US
Telephone Number	:	507-345-7012
Fax Number	:	507-388-6937

Provider Business Practice Location Address
First Line	:	220 E MAIN ST STE 1
Second Line	:
City	:	MANKATO
State	:	MN
Zip	:	56001-3574
Country	:	US
Telephone Number	:	507-345-7012
Fax Number	:	507-388-6937

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2019
Last Update Date	:	07/10/2019

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