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General NPI Number Information
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NPI Number | 1851512115
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Entity Type | Individual
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Provider Name | MARY PENELOPE BARTZEN OTR
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Gender | Female
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 303 CATLIN ST
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City | BUFFALO
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State | MN
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Zip | 55313-1947
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Country | US
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Telephone | 763-684-3855
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Fax |
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Provider Business Mailing Address
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Address Line | 1075 OAK CIR
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City | WAYZATA
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State | MN
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Zip | 55391-9680
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Country | US
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Telephone | 763-475-3339
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Fax | 763-684-3884
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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 | 101096
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License Number State | MN
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