Provider Demographics
NPI:1447528203
Name:ULRICH, WHITNEY (OT)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:ULRICH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:309 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56278
Mailing Address - Country:US
Mailing Address - Phone:320-839-4271
Mailing Address - Fax:320-839-4196
Practice Address - Street 1:309 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ORTONVILLE
Practice Address - State:MN
Practice Address - Zip Code:56278-1357
Practice Address - Country:US
Practice Address - Phone:320-839-4271
Practice Address - Fax:320-839-4196
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104035225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist