1013335132 NPI number — MARY RUST O.T

Table of content: MARY RUST O.T (NPI 1013335132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013335132 NPI number — MARY RUST O.T

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUST
Provider First Name:
MARY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.T
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013335132
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
81 W KRAFT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55118-3816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-600-9826
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
81 W KRAFT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55118-3816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-600-9826
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/05/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171W00000X , with the licence number:  100577 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171W00000X , with the licence number: OT 60446052 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171W00000X , with the licence number: OTR2691 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: OT 60446052 . This is a "OCCUPATIONAL THERAPY LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: OTR2691 . This is a "OCCUPATIONAL THERAPY LICENSE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 100577 . This is a "OCCUPATIONAL THERAPY LICENSE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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