Healthcare Provider Details

I. General information

NPI: 1356258750
Provider Name (Legal Business Name): ASHLEY SPROUSE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 PRAIRIE CENTER DR
EDEN PRAIRIE MN
55344-5375
US

IV. Provider business mailing address

4707 HAZELTINE LN
EAGAN MN
55123-2172
US

V. Phone/Fax

Practice location:
  • Phone: 866-552-3913
  • Fax:
Mailing address:
  • Phone: 314-322-3862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: