Healthcare Provider Details

I. General information

NPI: 1548197361
Provider Name (Legal Business Name): KRISTI ANN FICKES MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3764 95TH AVE NE
CIRCLE PINES MN
55014-3849
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 651-415-6200
  • Fax:
Mailing address:
  • Phone: 651-415-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number104526
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: