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General NPI Number Information
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NPI Number | 1033320650
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Entity Type | Individual
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Provider Name | ROBERTA BEA WOLLAN
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Gender | Female
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 900 MAIN ST W
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City | CANNON FALLS
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State | MN
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Zip | 55009-1852
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Country | US
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Telephone | 507-263-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 13186 GARNET AVE
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City | APPLE VALLEY
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State | MN
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Zip | 55124-6108
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 1009251
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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