Provider Demographics
NPI:1093169005
Name:WOLF-EGGEBRECHT, RUTH (OTR/L, CLT, DRS)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:WOLF-EGGEBRECHT
Suffix:
Gender:F
Credentials:OTR/L, CLT, DRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-4441
Mailing Address - Country:US
Mailing Address - Phone:218-829-2501
Mailing Address - Fax:
Practice Address - Street 1:804 WRIGHT ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-4441
Practice Address - Country:US
Practice Address - Phone:218-829-2501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101507225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist