Katherine Claire Dittmann, COTA

Individual provider Active NPI Occupational Therapy Assistant · Wadena, MN

NPI 1386808293 · NPPES record last updated Jan 7, 2013

Key facts

NPI
1386808293
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
201790 (MN)
Practice address
415 Jefferson St N
Wadena, MN 56482-1264
Phone
(218) 631-7475
NPI assigned
Jul 10, 2008
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
201790MNMDOccupational Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 201790 MN Yes

Addresses

Primary practice location

415 Jefferson St N
Wadena, MN 56482-1264

Mailing address

415 Jefferson St N
Wadena, MN 56482-1264
Phone (218) 631-7475

Other providers in Wadena, MN

All providers in Wadena, MN · Occupational Therapy Assistant in Minnesota

Sources for this page

Verify at the official NPI Registry.