Provider Demographics
NPI:1356362628
Name:MAETZOLD, PATRICIA S (OTRL PT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:S
Last Name:MAETZOLD
Suffix:
Gender:F
Credentials:OTRL PT
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:S
Other - Last Name:DEWAARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL PT
Mailing Address - Street 1:3915 GOLDEN VALLEY ROAD
Mailing Address - Street 2:COURAGE CENTER
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4298
Mailing Address - Country:US
Mailing Address - Phone:763-520-0494
Mailing Address - Fax:763-520-0355
Practice Address - Street 1:3915 GOLDEN VALLEY ROAD
Practice Address - Street 2:COURAGE CENTER
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4298
Practice Address - Country:US
Practice Address - Phone:763-520-0494
Practice Address - Fax:763-520-0355
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103328225X00000X
IA01566225X00000X
MN2220225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist