Provider Demographics
NPI:1740477678
Name:SCANLAN, RITA LYNN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:RITA
Middle Name:LYNN
Last Name:SCANLAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31147 PENINSULA AVE
Mailing Address - Street 2:
Mailing Address - City:LINDSTROM
Mailing Address - State:MN
Mailing Address - Zip Code:55045-9300
Mailing Address - Country:US
Mailing Address - Phone:651-257-6192
Mailing Address - Fax:651-257-1680
Practice Address - Street 1:604 NE 1ST ST
Practice Address - Street 2:BIRCHWOOD HEALTH CARE CENTER
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025
Practice Address - Country:US
Practice Address - Phone:651-464-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100628225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist