Provider Demographics
NPI:1629486972
Name:ALBRIGHT, MARA LYNN
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:LYNN
Last Name:ALBRIGHT
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 1:6967 WYNDHAM BAY
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2766
Mailing Address - Country:US
Mailing Address - Phone:651-501-5928
Mailing Address - Fax:
Practice Address - Street 1:7555 BAILEY RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129-9610
Practice Address - Country:US
Practice Address - Phone:651-209-9160
Practice Address - Fax:651-458-0241
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102334225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist