Provider Demographics
NPI:1942727045
Name:LINDBERG, TESSA (OTR/L)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17535 PINE HAVEN DR NW UNIT 2
Mailing Address - Street 2:
Mailing Address - City:PINEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56676-4722
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3835 SUPREME CT NW STE 2
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-4485
Practice Address - Country:US
Practice Address - Phone:218-444-8280
Practice Address - Fax:218-444-8337
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105469225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist