Provider Demographics
NPI:1871658062
Name:OTTER TAIL COUNTY
Entity Type:Organization
Organization Name:OTTER TAIL COUNTY
Other - Org Name:IND SCHOOL DIST 545
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WANEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-583-2927
Mailing Address - Street 1:500 SCHOOL AVE
Mailing Address - Street 2:
Mailing Address - City:HENNING
Mailing Address - State:MN
Mailing Address - Zip Code:56551-4003
Mailing Address - Country:US
Mailing Address - Phone:218-583-2927
Mailing Address - Fax:218-583-2312
Practice Address - Street 1:500 SCHOOL AVE
Practice Address - Street 2:
Practice Address - City:HENNING
Practice Address - State:MN
Practice Address - Zip Code:56551-4003
Practice Address - Country:US
Practice Address - Phone:218-583-2927
Practice Address - Fax:218-583-2312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN530095900Medicaid