Healthcare Provider Details

I. General information

NPI: 1366796914
Provider Name (Legal Business Name): LAURA KATIE DEERING OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 W 106TH ST
BLOOMINGTON MN
55431-4126
US

IV. Provider business mailing address

1350 W 106TH ST
BLOOMINGTON MN
55431-4126
US

V. Phone/Fax

Practice location:
  • Phone: 952-681-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number104274
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: