MEDICARE: KELLI ANN KAETTERHENRY 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
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1588867154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI ANN KAETTERHENRY OTR

Provider Business Mailing Address
First Line	:	6776 LAKE DR STE 170
Second Line	:
City	:	CIRCLE PINES
State	:	MN
Zip	:	55014-1156
Country	:	US
Telephone Number	:	651-784-7007
Fax Number	:

Provider Business Practice Location Address
First Line	:	6776 LAKE DR STE 170
Second Line	:
City	:	CIRCLE PINES
State	:	MN
Zip	:	55014-1156
Country	:	US
Telephone Number	:	651-784-7007
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	07/08/2007

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