Healthcare Provider Details

I. General information

NPI: 1306928940
Provider Name (Legal Business Name): JACQUELINE MARIE STEFFENHAGEN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE MARIE SELIGA OTR/L

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 CENTRAL PARK VILLAGE DR STE 130
EAGAN MN
55121-7707
US

IV. Provider business mailing address

2865 UPPER 62ND ST E
INVER GROVE HEIGHTS MN
55076-1538
US

V. Phone/Fax

Practice location:
  • Phone: 651-406-8868
  • Fax:
Mailing address:
  • Phone: 651-451-4406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number102413
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: