Healthcare Provider Details

I. General information

NPI: 1326406570
Provider Name (Legal Business Name): BHAKTI OCCUPATIONAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 08/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7550 FRANCE AVE S SUITE 220
EDINA MN
55435-5624
US

IV. Provider business mailing address

7550 FRANCE AVE S SUITE 220
EDINA MN
55435-5624
US

V. Phone/Fax

Practice location:
  • Phone: 612-859-7709
  • Fax:
Mailing address:
  • Phone: 612-859-7709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: SHANTE FAUSKEE
Title or Position: CLINIC MANAGER
Credential:
Phone: 612-524-9237