MEDICARE: MISS TANYA MARIE ACKER OTR

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	225X00000X	Occupational Therapist	103376	MN

General Provider Information

NPI Number	:	1508986415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TANYA MARIE ACKER OTR

Provider Business Mailing Address
First Line	:	4419 NEVADA AVE N
Second Line	:
City	:	NEW HOPE
State	:	MN
Zip	:	55428-5037
Country	:	US
Telephone Number	:	715-529-0345
Fax Number	:

Provider Business Practice Location Address
First Line	:	4419 NEVADA AVE N
Second Line	:
City	:	NEW HOPE
State	:	MN
Zip	:	55428-5037
Country	:	US
Telephone Number	:	715-529-0345
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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