Provider Demographics
NPI:1629436225
Name:MOEN, MARALEE KAREN (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:MARALEE
Middle Name:KAREN
Last Name:MOEN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11101 CTY. RD. 16 NW
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56326
Mailing Address - Country:US
Mailing Address - Phone:320-524-2425
Mailing Address - Fax:
Practice Address - Street 1:1020 LARK ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2269
Practice Address - Country:US
Practice Address - Phone:320-762-1125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN200826224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant