Healthcare Provider Details

I. General information

NPI: 1629486972
Provider Name (Legal Business Name): MARA LYNN ALBRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7555 BAILEY RD
WOODBURY MN
55129-9610
US

IV. Provider business mailing address

6967 WYNDHAM BAY
WOODBURY MN
55125-2766
US

V. Phone/Fax

Practice location:
  • Phone: 651-209-9160
  • Fax: 651-458-0241
Mailing address:
  • Phone: 651-501-5928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number102334
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: