MEDICARE: SHERRY LYNAE LOEN-BAKKE 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
1	225X00000X	Occupational Therapist	16	ND

General Provider Information

NPI Number	:	1558521757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRY LYNAE LOEN-BAKKE OTR/L

Provider Business Mailing Address
First Line	:	652 130TH AVE NE
Second Line	:
City	:	FINLEY
State	:	ND
Zip	:	58230-9441
Country	:	US
Telephone Number	:	701-789-1026
Fax Number	:	701-524-1394

Provider Business Practice Location Address
First Line	:	652 130TH AVE NE
Second Line	:
City	:	FINLEY
State	:	ND
Zip	:	58230-9441
Country	:	US
Telephone Number	:	701-789-1026
Fax Number	:	701-524-1394

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

Provider Enumeration Date	:	06/11/2008
Last Update Date	:	06/11/2008

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Directions to “ SHERRY LYNAE LOEN-BAKKE OTR/L” Practice Location

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