Provider Demographics
NPI:1518578756
Name:DUSEK, SIRI KIANNA (OTR/L)
Entity Type:Individual
Prefix:
First Name:SIRI
Middle Name:KIANNA
Last Name:DUSEK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20288 HIGHWAY 15 N STE 100
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-5685
Mailing Address - Country:US
Mailing Address - Phone:320-587-2326
Mailing Address - Fax:
Practice Address - Street 1:20288 HIGHWAY 15 N STE 100
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-5685
Practice Address - Country:US
Practice Address - Phone:320-587-2326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106301225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN106301OtherMINNESOTA BOARD OF OCCUPATIONAL THERAPY