Facts
- Status
- A
- Credential
- COTA
- Type
- Individual
- Enumeration date
- 2025-05-05
- Last updated
- 2025-05-05
Specialties
Licenses
- License MN
- 202762
Location
- Practice location
- 705 6TH ST
- City
- WINDOM MN
- Postal code
- 561011814
- Phone
- 800-304-7152
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.