Healthcare Provider Details

I. General information

NPI: 1467300160
Provider Name (Legal Business Name): STACY M PFARR OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 RED PINE LN
EAGAN MN
55123-2182
US

IV. Provider business mailing address

15120 PORTLAND AVE
BURNSVILLE MN
55306-5005
US

V. Phone/Fax

Practice location:
  • Phone: 651-423-7870
  • Fax:
Mailing address:
  • Phone: 612-802-3883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number102531
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: