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NPI Code Detail

MEDICARE: JAIDEN KRISTINE WENTZ OT

MEDICARE: JAIDEN KRISTINE WENTZ OT
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
1225X00000XOccupational Therapist105677MN

General Provider Information

NPI Number : 1770079527
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAIDEN KRISTINE WENTZ OT
Provider Business Mailing Address
First Line : 14387 EDGEWOOD DR
Second Line :
City : BAXTER
State : MN
Zip : 56425-8460
Country : US
Telephone Number : 952-544-0349
Fax Number :
Provider Business Practice Location Address
First Line : 14387 EDGEWOOD DR
Second Line :
City : BAXTER
State : MN
Zip : 56425-8460
Country : US
Telephone Number : 952-544-0349
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2018
Last Update Date : 05/27/2021

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Directions to “ JAIDEN KRISTINE WENTZ OT” Practice Location

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