Provider Demographics
NPI:1447499108
Name:DUNLAP RUDEEN, MARY CLAIRE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:CLAIRE
Last Name:DUNLAP RUDEEN
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 1:11160 PAWNEE AVE N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-9222
Mailing Address - Country:US
Mailing Address - Phone:651-439-6265
Mailing Address - Fax:
Practice Address - Street 1:1875 GREELEY ST S
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6079
Practice Address - Country:US
Practice Address - Phone:651-351-8365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN280016225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist