Provider Demographics
NPI:1235290875
Name:MEDLEY, MARGARET ANN (OT)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ANN
Last Name:MEDLEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 COUNTY ROAD 120
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303
Mailing Address - Country:US
Mailing Address - Phone:320-259-5429
Mailing Address - Fax:320-240-8905
Practice Address - Street 1:251 COUNTY ROAD 120
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-259-5429
Practice Address - Fax:320-240-8905
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100331225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN264M1NOOtherBLUE CROSS BLUE SHIELD OF MN
MN6405361OtherMEDICA
MNHP43509OtherHEALTHPARTNERS
MN4G184MEOtherBLUE CROSS BLUE SHIELD
MN6405361OtherSELECT CARE
MN991323800Medicaid
MNP01077777Medicare PIN
MN670000092Medicare PIN
MN670000091Medicare PIN