Healthcare Provider Details

I. General information

NPI: 1689304750
Provider Name (Legal Business Name): DANIELLE RAE RUZICKA OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE RAE HILDEBRANDT OT

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 DREW AVE SE
MADELIA MN
56062-1841
US

IV. Provider business mailing address

2 CRYSTAL CT
SAINT JAMES MN
56081-2045
US

V. Phone/Fax

Practice location:
  • Phone: 507-642-3255
  • Fax:
Mailing address:
  • Phone: 507-317-7276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number104904
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: