Provider Demographics
NPI:1841418647
Name:MUELLER, NICOLE MARNES (OTR)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARNES
Last Name:MUELLER
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 1:82 100TH ST SW
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55388-8701
Mailing Address - Country:US
Mailing Address - Phone:952-955-2416
Mailing Address - Fax:952-955-2010
Practice Address - Street 1:204 LEWIS AVE S
Practice Address - Street 2:STE #210
Practice Address - City:WATERTOWN
Practice Address - State:MN
Practice Address - Zip Code:55388-4500
Practice Address - Country:US
Practice Address - Phone:952-955-2242
Practice Address - Fax:952-955-2010
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101619225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN21F09MUOtherBCBS MN
MNHP43065OtherHEALTH PARTNERS