Provider Demographics
NPI:1205070240
Name:BEISE, LUCINDA G (COTA)
Entity type:Individual
Prefix:
First Name:LUCINDA
Middle Name:G
Last Name:BEISE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 AURORA CIR
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-1328
Mailing Address - Country:US
Mailing Address - Phone:651-380-3964
Mailing Address - Fax:
Practice Address - Street 1:1412 W 4TH ST
Practice Address - Street 2:RED WING HEALTH CARE CENTER
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-2107
Practice Address - Country:US
Practice Address - Phone:651-388-2843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN200645224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant