Healthcare Provider Details

I. General information

NPI: 1982517025
Provider Name (Legal Business Name): KARLI JEAN GREEN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 W 81ST ST STE 103
BLOOMINGTON MN
55437-1111
US

IV. Provider business mailing address

4801 W 81ST ST STE 103
BLOOMINGTON MN
55437-1111
US

V. Phone/Fax

Practice location:
  • Phone: 612-249-5448
  • Fax: 952-924-0314
Mailing address:
  • Phone: 612-249-5448
  • Fax: 952-924-0314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number108139
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: