Healthcare Provider Details

I. General information

NPI: 1932015849
Provider Name (Legal Business Name): ANGELA MICHELE KELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 RIDGEVIEW DR
EDINA MN
55439-1230
US

IV. Provider business mailing address

6301 RIDGEVIEW DR
EDINA MN
55439-1230
US

V. Phone/Fax

Practice location:
  • Phone: 952-201-2365
  • Fax:
Mailing address:
  • Phone: 952-201-2365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number102167
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: