Healthcare Provider Details

I. General information

NPI: 1356254957
Provider Name (Legal Business Name): MARY MARGARET MCCORMICK OTD OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7141 YORK AVE S
EDINA MN
55435-4512
US

IV. Provider business mailing address

225 PORTLAND AVE UNIT 547
MINNEAPOLIS MN
55401-2631
US

V. Phone/Fax

Practice location:
  • Phone: 952-253-0226
  • Fax:
Mailing address:
  • Phone: 262-893-2108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: