MEDICARE: MRS. SALLY RAE STIEN MS 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
1	225XP0019X	Physical Rehabilitation Occupational Therapist	3203	CO
2	225XP0019X	Physical Rehabilitation Occupational Therapist	002174	IA
3	225XP0019X	Physical Rehabilitation Occupational Therapist	0736	SD

General Provider Information

NPI Number	:	1851661086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SALLY RAE STIEN MS OTR/L

Provider Business Mailing Address
First Line	:	4004 S KLEIN AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-7230
Country	:	US
Telephone Number	:	651-341-0399
Fax Number	:

Provider Business Practice Location Address
First Line	:	4004 S KLEIN AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-7230
Country	:	US
Telephone Number	:	651-341-0399
Fax Number	:

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

Provider Enumeration Date	:	01/04/2012
Last Update Date	:	01/04/2012

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