Provider Demographics
NPI:1508986415
Name:ACKER, TANYA MARIE (OTR)
Entity Type:Individual
Prefix:MISS
First Name:TANYA
Middle Name:MARIE
Last Name:ACKER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4419 NEVADA AVE N
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55428-5037
Mailing Address - Country:US
Mailing Address - Phone:715-529-0345
Mailing Address - Fax:
Practice Address - Street 1:4419 NEVADA AVE N
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55428-5037
Practice Address - Country:US
Practice Address - Phone:715-529-0345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103376225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist