Healthcare Provider Details

I. General information

NPI: 1568308146
Provider Name (Legal Business Name): AMY KAPAUN CARLSON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SCHOOL RD
CIRCLE PINES MN
55014-1783
US

IV. Provider business mailing address

2540 COUNTY ROAD F E
WHITE BEAR LAKE MN
55110-3935
US

V. Phone/Fax

Practice location:
  • Phone: 763-792-5900
  • Fax:
Mailing address:
  • Phone: 651-415-5510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number200860
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: