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NPI Code Detail

MEDICARE: MRS. LORI JEAN RUDA OTR

MEDICARE: MRS. LORI JEAN RUDA OTR
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 Therapist102908MN

General Provider Information

NPI Number : 1962470278
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LORI JEAN RUDA OTR
Provider Business Mailing Address
First Line : 8662 ELK AVE
Second Line :
City : MONTICELLO
State : MN
Zip : 55362-2805
Country : US
Telephone Number : 763-295-4987
Fax Number :
Provider Business Practice Location Address
First Line : 5700 BOTTINEAU BLVD
Second Line : SUITE 200
City : CRYSTAL
State : MN
Zip : 55429-3183
Country : US
Telephone Number : 763-535-7607
Fax Number : 763-535-7649
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2006
Last Update Date : 04/23/2013

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Directions to “ MRS. LORI JEAN RUDA OTR” Practice Location

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