Healthcare Provider Details

I. General information

NPI: 1699013136
Provider Name (Legal Business Name): MANDA RINGDAHL OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 SHELBY RD
LA CROSSE WI
54601-8037
US

IV. Provider business mailing address

2501 SHELBY RD
LA CROSSE WI
54601-8037
US

V. Phone/Fax

Practice location:
  • Phone: 608-788-5700
  • Fax:
Mailing address:
  • Phone: 608-788-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5128-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: