Healthcare Provider Details

I. General information

NPI: 1689215055
Provider Name (Legal Business Name): EMILY BEDKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY JOHNSON

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
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
55431-4152
US

V. Phone/Fax

Practice location:
  • Phone: 952-681-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: