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General NPI Number Information
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NPI Number | 1396541207
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Entity Type | Individual
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Provider Name | MARCIE ANN DRAYTON
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Gender | Female
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Dates
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Enumeration Date | 02/21/2025
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 5200 FAIRVIEW BLVD
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City | WYOMING
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State | MN
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Zip | 55092-8013
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Country | US
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Telephone | 651-982-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 22865 HENNA AVE N
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City | FOREST LAKE
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State | MN
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Zip | 55025-8549
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Country | US
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Telephone | 651-442-3371
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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 | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | 107260
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License Number State | MN
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