MEDICARE: OTTER TAIL COUNTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1003997859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OTTER TAIL COUNTY

Provider Business Mailing Address
First Line	:	402 SUMMIT ST W
Second Line	:
City	:	BATTLE LAKE
State	:	MN
Zip	:	56515-4029
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 SUMMIT ST W
Second Line	:
City	:	BATTLE LAKE
State	:	MN
Zip	:	56515-4029
Country	:	US
Telephone Number	:	218-864-5215
Fax Number	:	218-864-8651

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	RICK BLEICHNER
Credential	:
Telephone Number	:	218-864-5215

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	06/17/2008

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Directions to “OTTER TAIL COUNTY ” Practice Location

Language	Start Address	Practice Location

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