Provider Demographics
NPI:1083916050
Name:ACEITUNO, MARIE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:
Last Name:ACEITUNO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1772 STEIGER LAKE LN STE 100
Mailing Address - Street 2:PO BOX 34
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-7723
Mailing Address - Country:US
Mailing Address - Phone:952-443-9888
Mailing Address - Fax:952-443-9804
Practice Address - Street 1:1772 STEIGER LAKE LN
Practice Address - Street 2:SUITE 100
Practice Address - City:VICTORIA
Practice Address - State:MN
Practice Address - Zip Code:55386-7723
Practice Address - Country:US
Practice Address - Phone:952-443-9888
Practice Address - Fax:952-443-9804
Is Sole Proprietor?:No
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN201664224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant