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NPI Code Detail

MEDICARE: OLIVIA PEMBERTON OTR/L

MEDICARE: OLIVIA PEMBERTON OTR/L
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
1225XP0019XPhysical Rehabilitation Occupational Therapist104340MN

General Provider Information

NPI Number : 1497328918
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLIVIA PEMBERTON OTR/L
Provider Business Mailing Address
First Line : 16360 HIGHWAY 7
Second Line :
City : NEW GERMANY
State : MN
Zip : 55367-9510
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1095 HIGHWAY 15 S
Second Line :
City : HUTCHINSON
State : MN
Zip : 55350-5000
Country : US
Telephone Number : 320-484-4410
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2021
Last Update Date : 07/22/2021

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Directions to “ OLIVIA PEMBERTON OTR/L” Practice Location

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