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NPI Code Detail

MEDICARE: KARLA JEAN ETHIER OTR

MEDICARE: KARLA JEAN ETHIER 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
1225X00000XOccupational Therapist103269MN

General Provider Information

NPI Number : 1932403185
Entity Type Code : Individual
Provider Name (Legal Business Name) : KARLA JEAN ETHIER OTR
Provider Business Mailing Address
First Line : 1670 LEGACY PKWY E
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55109-5469
Country : US
Telephone Number : 651-777-1641
Fax Number :
Provider Business Practice Location Address
First Line : 1670 LEGACY PKWY E
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55109-5469
Country : US
Telephone Number : 651-777-1641
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2011
Last Update Date : 01/03/2011

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