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NPI Code Detail

MEDICARE: MARA FENSKE OTR/L

MEDICARE: MARA FENSKE 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 Therapist

General Provider Information

NPI Number : 1588336622
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARA FENSKE OTR/L
Provider Business Mailing Address
First Line : 12400 PORTLAND AVE STE 140
Second Line :
City : BURNSVILLE
State : MN
Zip : 55337-6805
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12400 PORTLAND AVE STE 140
Second Line :
City : BURNSVILLE
State : MN
Zip : 55337-6805
Country : US
Telephone Number : 952-428-0409
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2021
Last Update Date : 06/16/2022

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