Provider Demographics
NPI:1215155445
Name:WILSON-STUCKE, RACHEL MARIE (OTR)
Entity type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:MARIE
Last Name:WILSON-STUCKE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16975 FIELDCREST AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-8834
Mailing Address - Country:US
Mailing Address - Phone:952-432-4599
Mailing Address - Fax:
Practice Address - Street 1:16975 FIELDCREST AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-8834
Practice Address - Country:US
Practice Address - Phone:952-432-4599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101816225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist