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NPI Code Detail

MEDICARE: CARRIE PETERSON OTR

MEDICARE: CARRIE PETERSON OTR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist103124MN

General Provider Information

NPI Number : 1134232952
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARRIE PETERSON OTR
Provider Business Mailing Address
First Line : 1939 MINNEHAHA AVE W
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-1033
Country : US
Telephone Number : 651-748-4338
Fax Number : 651-748-2892
Provider Business Practice Location Address
First Line : 11800 XEON BLVD NW
Second Line :
City : COON RAPIDS
State : MN
Zip : 55448-2061
Country : US
Telephone Number : 763-489-3638
Fax Number : 763-647-3885
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2006
Last Update Date : 09/12/2023

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