Healthcare Provider Details

I. General information

NPI: 1932037645
Provider Name (Legal Business Name): ELIZABETH PERRA OTR/L, OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 LAKE VALENTINE RD
ARDEN HILLS MN
55112-2841
US

IV. Provider business mailing address

3164 W OWASSO BLVD
ROSEVILLE MN
55113-2166
US

V. Phone/Fax

Practice location:
  • Phone: 651-621-6000
  • Fax:
Mailing address:
  • Phone: 612-860-2430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number101901
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: