Active NPI
Mary Lou Wittmann, OTR/L
- Occupational Therapist
- Crookston, MN
National Provider Identifier
1245585751
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 533
- Practice address
- 323 S Minnesota St
Crookston, MN 56716-1601 - Phone
- (218) 281-9462
- Fax
- (218) 281-9336
- NPI assigned
- Jul 20, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 102843 | MN | |
| Occupational Therapist | 225X00000X | 533 | ND | Primary |
Addresses
Primary practice location
323 S Minnesota St
Crookston, MN 56716-1601
Mailing address
323 S Minnesota St
Crookston, MN 56716-1601
Phone (218) 281-9462
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 410724029 | Other | TAX ID# |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 102843 | MN | MD | Occupational Therapist |
| 533 | ND | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1342742400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1342742400000",
"number": "1245585751",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "323 S MINNESOTA ST",
"city": "CROOKSTON",
"state": "MN",
"postal_code": "567161601",
"telephone_number": "218-281-9462",
"fax_number": "218-281-9336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "323 S MINNESOTA ST",
"city": "CROOKSTON",
"state": "MN",
"postal_code": "567161601",
"telephone_number": "218-281-9462",
"fax_number": "218-281-9336"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WITTMANN",
"first_name": "MARY",
"middle_name": "LOU",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-07-20",
"last_updated": "2012-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MN",
"license": "102843",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "ND",
"license": "533",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID#",
"identifier": "410724029",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Crookston, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.