Healthcare Provider Details

I. General information

NPI: 1518519644
Provider Name (Legal Business Name): NANCY COLLEEN HUKKA OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E 37TH ST STE 20
HIBBING MN
55746-2972
US

IV. Provider business mailing address

12677 BEAUTY MOUNTAIN RD
HIBBING MN
55746-8065
US

V. Phone/Fax

Practice location:
  • Phone: 218-440-1548
  • Fax:
Mailing address:
  • Phone: 218-969-0587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number136708
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number100413
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: