Provider Demographics
NPI:1851512115
Name:BARTZEN, MARY PENELOPE (OTR)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PENELOPE
Last Name:BARTZEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:M
Other - Middle Name:PENNY
Other - Last Name:BARTZEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTRLL
Mailing Address - Street 1:1075 OAK CIR
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-9680
Mailing Address - Country:US
Mailing Address - Phone:763-475-3339
Mailing Address - Fax:763-684-3884
Practice Address - Street 1:303 CATLIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-1947
Practice Address - Country:US
Practice Address - Phone:763-684-3855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101096225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist