Healthcare Provider Details

I. General information

NPI: 1013008069
Provider Name (Legal Business Name): ROSE HANSEN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 4TH AVE N
SAUK RAPIDS MN
56379-2201
US

IV. Provider business mailing address

15762 RIVERBEND LN
COLD SPRING MN
56320-8724
US

V. Phone/Fax

Practice location:
  • Phone: 763-689-5385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number100680
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: