Healthcare Provider Details

I. General information

NPI: 1417161381
Provider Name (Legal Business Name): MARY ANN OSTENDORF CMF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 01/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 W GALENA AVE
FREEPORT IL
61032-0655
US

IV. Provider business mailing address

PO BOX 655
FREEPORT IL
61032-0655
US

V. Phone/Fax

Practice location:
  • Phone: 815-235-1551
  • Fax:
Mailing address:
  • Phone: 815-235-1551
  • Fax: 815-235-1551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: