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NPI Code Detail

MEDICARE: MS. DARCY BODGER OTR/L

MEDICARE: MS. DARCY BODGER 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
1174400000XSpecialist100009MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1100009OTHERMNMN LICENSE

General Provider Information

NPI Number : 1689917528
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DARCY BODGER OTR/L
Provider Business Mailing Address
First Line : 1250 W BROADWAY AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55411-2533
Country : US
Telephone Number : 612-668-0000
Fax Number :
Provider Business Practice Location Address
First Line : 1250 W BROADWAY AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55411-2533
Country : US
Telephone Number : 612-668-2053
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2013
Last Update Date : 01/08/2026

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