Healthcare Provider Details

I. General information

NPI: 1386184711
Provider Name (Legal Business Name): SAMANTHA WOJTA OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2017
Last Update Date: 03/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 28TH ST SISTER KENNY REHABILITATION INSTITUTE
MINNEAPOLIS MN
55407-3723
US

IV. Provider business mailing address

8135 KIMBERLY LN N
MAPLE GROVE MN
55311-1775
US

V. Phone/Fax

Practice location:
  • Phone: 763-236-6645
  • Fax:
Mailing address:
  • Phone: 763-607-7128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number105352
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: