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NPI Code Detail

MEDICARE: ERICKA MICHELLE NIEMANN OT

MEDICARE: ERICKA MICHELLE NIEMANN OT
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
1225X00000XOccupational Therapist105807MN

General Provider Information

NPI Number : 1124591995
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERICKA MICHELLE NIEMANN OT
Provider Business Mailing Address
First Line : 211 7TH ST E APT 101
Second Line :
City : SAINT PAUL
State : MN
Zip : 55101-2383
Country : US
Telephone Number : 970-381-2562
Fax Number :
Provider Business Practice Location Address
First Line : 1670 LEGACY PKWY E
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55109-5469
Country : US
Telephone Number : 970-381-2562
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2019
Last Update Date : 01/04/2019

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