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General NPI Number Information
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NPI Number | 1770389496
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Entity Type | Individual
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Provider Name | GRETTA GRACE BECKER
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Gender | Female
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Dates
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Enumeration Date | 02/22/2025
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Last Update Date | 02/22/2025
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Provider Practice Location Address
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Address Line | 1104 E RIVER ST.
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City | MONTICELLO
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State | MN
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Zip | 55362
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Country | US
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Telephone | 320-251-8181
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Fax |
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Provider Business Mailing Address
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Address Line | 10705 TRIDEN RIDGE CIRCLE
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City | ROGERS
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State | MN
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Zip | 55374
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Country | US
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Telephone | 763-318-1325
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 202777
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License Number State | MN
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