Healthcare Provider Details

I. General information

NPI: 1942246053
Provider Name (Legal Business Name): SUPREET BUDHRAJA KATHPALIA MS.OTR L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 COBBLESTONE LANE COURAGE BURNSVILLE
BURNSVILLE MN
55306
US

IV. Provider business mailing address

100 COBBLESTONE LANE COURAGE BURNSVILLE
BURNSVILLE MN
55306
US

V. Phone/Fax

Practice location:
  • Phone: 952-898-5700
  • Fax: 952-898-5757
Mailing address:
  • Phone: 952-898-5700
  • Fax: 952-898-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number102853
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number102853
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: