Healthcare Provider Details

I. General information

NPI: 1730131384
Provider Name (Legal Business Name): RENAE ELLEN BIEBL OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENAE ELLEN SIEWERT

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 NORTHLAND DR
BLOOMINGTON MN
55431-4800
US

IV. Provider business mailing address

8100 NORTHLAND DR
BLOOMINGTON MN
55431-4800
US

V. Phone/Fax

Practice location:
  • Phone: 952-831-8742
  • Fax: 952-831-1626
Mailing address:
  • Phone: 952-831-8742
  • Fax: 952-831-1626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number102651
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: