Provider Demographics
NPI:1396158697
Name:WILMES, NATALIE RENE (OTR/L)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:RENE
Last Name:WILMES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:RENE
Other - Last Name:WILMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:209 10TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55075-1923
Mailing Address - Country:US
Mailing Address - Phone:651-387-1464
Mailing Address - Fax:
Practice Address - Street 1:490 HIGHWAY 96 W STE 300
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-1961
Practice Address - Country:US
Practice Address - Phone:651-451-3016
Practice Address - Fax:651-481-7040
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1013563225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist