Provider Demographics
NPI:1871733766
Name:MUTCHLER, JOAN F (OT)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:F
Last Name:MUTCHLER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:F
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:PO BOX 3450
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-3450
Mailing Address - Country:US
Mailing Address - Phone:605-644-4000
Mailing Address - Fax:
Practice Address - Street 1:1440 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-1505
Practice Address - Country:US
Practice Address - Phone:605-644-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0005225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0005OtherLICENSE