Healthcare Provider Details

I. General information

NPI: 1184761843
Provider Name (Legal Business Name): LYNN MARIE WILBUR OTR, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 NORTHLAND DR
BLOOMINGTON MN
55431-4800
US

IV. Provider business mailing address

4327 FRANCE AVE S
MINNEAPOLIS MN
55410-1344
US

V. Phone/Fax

Practice location:
  • Phone: 952-831-8742
  • Fax:
Mailing address:
  • Phone: 612-928-7091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number101106
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: