Healthcare Provider Details

I. General information

NPI: 1568306447
Provider Name (Legal Business Name): NAOMI RUTH TAGUE-HAMLIN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 BUCHANAN ST N STE 150
CAMBRIDGE MN
55008-1640
US

IV. Provider business mailing address

2352 335TH AVE NE
CAMBRIDGE MN
55008-1381
US

V. Phone/Fax

Practice location:
  • Phone: 763-552-7733
  • Fax: 763-552-7739
Mailing address:
  • Phone: 763-310-9382
  • Fax: 763-552-7739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number100124
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: