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NPI Code Detail

MEDICARE: ELIANA NICOLE STIENESSEN MAOT, OTR/L

MEDICARE: ELIANA NICOLE STIENESSEN MAOT, 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 Therapist106404MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15757OTHERMNOCCUPATIONAL THERAPY PRACTICE LICENSE

General Provider Information

NPI Number : 1154957108
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIANA NICOLE STIENESSEN MAOT, OTR/L
Provider Business Mailing Address
First Line : 1404 10TH ST SE
Second Line :
City : WILLMAR
State : MN
Zip : 56201-5421
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2653 COUNTY ROAD 74
Second Line :
City : SAINT CLOUD
State : MN
Zip : 56301-2205
Country : US
Telephone Number : 320-229-4069
Fax Number : 320-229-4071
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2020
Last Update Date : 01/27/2022

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Directions to “ ELIANA NICOLE STIENESSEN MAOT, OTR/L” Practice Location

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