Healthcare Provider Details

I. General information

NPI: 1912837733
Provider Name (Legal Business Name): KELLY PREIMESBERGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 W 112TH ST
BLOOMINGTON MN
55437-3404
US

IV. Provider business mailing address

7751 W 96TH ST
BLOOMINGTON MN
55438-2911
US

V. Phone/Fax

Practice location:
  • Phone: 952-358-1477
  • Fax:
Mailing address:
  • Phone: 612-554-7955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number101896
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: