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General NPI Number Information
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NPI Number | 1104785773
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Entity Type | Individual
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Provider Name | MCKENNA LUDWIG OTD, OTR/L
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Gender |
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Dates
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Enumeration Date | 01/20/2026
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Last Update Date | 01/20/2026
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Provider Practice Location Address
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Address Line | 3700 CEDAR LAKE AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55416-4240
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Country | US
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Telephone | 612-920-2030
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Fax |
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Provider Business Mailing Address
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Address Line | 5600 CAMERATA WAY UNIT 235
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-5287
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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 | 107851
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License Number State | MN
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