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NPI Code Detail

MEDICARE: ELIZABETH STIENESSEN OTR/L

MEDICARE: ELIZABETH STIENESSEN OTR/L
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
1225X00000XOccupational TherapistMN101760MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1HP31768OTHERMNHEALTHPARTNERS ID
241163580956301B005OTHERMNCHAMPUS
36401064OTHERMNMEDICA PROVIDER ID
4181090OTHERMNMAYO MANAGEMENT ID
533G12STOTHERMNBCBS PROVIDER ID

General Provider Information

NPI Number : 1104809698
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH STIENESSEN OTR/L
Provider Business Mailing Address
First Line : 2835 W SAINT GERMAIN ST
Second Line : SUITE 300
City : SAINT CLOUD
State : MN
Zip : 56301-4743
Country : US
Telephone Number : 320-259-4151
Fax Number : 320-259-5707
Provider Business Practice Location Address
First Line : 2835 W SAINT GERMAIN ST
Second Line : SUITE 300
City : SAINT CLOUD
State : MN
Zip : 56301-4743
Country : US
Telephone Number : 320-259-4151
Fax Number : 320-259-5707
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2005
Last Update Date : 07/08/2007

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Directions to “ ELIZABETH STIENESSEN OTR/L” Practice Location

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