Healthcare Provider Details

I. General information

NPI: 1679832976
Provider Name (Legal Business Name): TORREY LEE HOVLAND OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24864 TRI LAKES DR
PELICAN RAPIDS MN
56572-7555
US

IV. Provider business mailing address

24864 TRI LAKES DR
PELICAN RAPIDS MN
56572-7555
US

V. Phone/Fax

Practice location:
  • Phone: 701-388-9731
  • Fax: 218-863-2215
Mailing address:
  • Phone: 701-388-9731
  • Fax: 218-863-2215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number959
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number104222
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: