Healthcare Provider Details

I. General information

NPI: 1194443101
Provider Name (Legal Business Name): CHELSEY MARIE JOY WEINTRAUB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEY MARIE JOY STRAIGHT

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12450 CLOUD DR NE
BLAINE MN
55449-6274
US

IV. Provider business mailing address

540 FALCON CREST DR
SPEARFISH SD
57783-3252
US

V. Phone/Fax

Practice location:
  • Phone: 763-777-7117
  • Fax: 651-401-0598
Mailing address:
  • Phone: 605-491-2832
  • Fax: 605-988-6648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number104612
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: