Provider Demographics
NPI:1962793653
Name:RONGLIEN, AUTUMN
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:RONGLIEN
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 1:900 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MN
Mailing Address - Zip Code:56256-1006
Mailing Address - Country:US
Mailing Address - Phone:132-069-8716
Mailing Address - Fax:
Practice Address - Street 1:900 2ND AVE STE 704
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MN
Practice Address - Zip Code:56256-1006
Practice Address - Country:US
Practice Address - Phone:132-069-8716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103972225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist