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General NPI Number Information
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NPI Number | 1992545974
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Entity Type | Individual
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Provider Name | WANDA SUE WITHINGTON OTR
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Gender | Female
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Dates
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Enumeration Date | 05/28/2024
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 9000 GOLDEN VALLEY RD
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City | CRYSTAL
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State | MN
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Zip | 55427-4471
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Country | US
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Telephone | 763-543-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 9000 GOLDEN VALLEY RD
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City | GOLDEN VALLEY
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State | MN
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Zip | 55427-4471
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Country | US
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Telephone | 763-543-9000
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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 | 101181
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License Number State | MN
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