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NPI Code Detail

MEDICARE: LINDA TALLAKSON C.O.T.A/L

MEDICARE: LINDA TALLAKSON C.O.T.A/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
1224Z00000XOccupational Therapy Assistant200509MN

General Provider Information

NPI Number : 1700248051
Entity Type Code : Individual
Provider Name (Legal Business Name) : LINDA TALLAKSON C.O.T.A/L
Provider Business Mailing Address
First Line : 5343 MORRIS THOMAS RD
Second Line :
City : HERMANTOWN
State : MN
Zip : 55810-9714
Country : US
Telephone Number : 218-340-4803
Fax Number :
Provider Business Practice Location Address
First Line : 4002 LONDON RD # RE
Second Line :
City : DULUTH
State : MN
Zip : 55804-2243
Country : US
Telephone Number : 218-625-8295
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2016
Last Update Date : 03/25/2016

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