Provider Demographics
NPI:1164730362
Name:OTTER TAIL COUNTY PUBLIC HEALTH
Entity Type:Organization
Organization Name:OTTER TAIL COUNTY PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPARTMENT HEAD
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:THORSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-998-8333
Mailing Address - Street 1:118 NORTH MAIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK MILLS
Mailing Address - State:MN
Mailing Address - Zip Code:56567
Mailing Address - Country:US
Mailing Address - Phone:218-385-5505
Mailing Address - Fax:218-385-3852
Practice Address - Street 1:118 NORTH MAIN AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK MILLS
Practice Address - State:MN
Practice Address - Zip Code:56567
Practice Address - Country:US
Practice Address - Phone:218-385-5505
Practice Address - Fax:218-385-3852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare