Provider Demographics
NPI:1427685320
Name:STEIDLER-THOMPSON, LYNN MARIE
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:STEIDLER-THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37051 159TH AVE
Mailing Address - Street 2:
Mailing Address - City:MENAHGA
Mailing Address - State:MN
Mailing Address - Zip Code:56464-6590
Mailing Address - Country:US
Mailing Address - Phone:320-334-4058
Mailing Address - Fax:
Practice Address - Street 1:24090 SMILEY RD STE 200
Practice Address - Street 2:
Practice Address - City:NISSWA
Practice Address - State:MN
Practice Address - Zip Code:56468-2946
Practice Address - Country:US
Practice Address - Phone:218-963-9452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102991225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist