Healthcare Provider Details

I. General information

NPI: 1205415569
Provider Name (Legal Business Name): REED ALLEN KOTZ OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W 94TH ST
BLOOMINGTON MN
55420-4206
US

IV. Provider business mailing address

2101 WOODDALE DR STE A
WOODBURY MN
55125-2933
US

V. Phone/Fax

Practice location:
  • Phone: 952-885-0418
  • Fax: 952-885-0173
Mailing address:
  • Phone: 651-738-9888
  • Fax: 651-738-9889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number106445
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: