Healthcare Provider Details

I. General information

NPI: 1831263201
Provider Name (Legal Business Name): JANET CASTERTON MOT OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 YORK AVE S
EDINA MN
55410-2831
US

IV. Provider business mailing address

6101 YORK AVE S
EDINA MN
55410-2831
US

V. Phone/Fax

Practice location:
  • Phone: 616-822-2334
  • Fax:
Mailing address:
  • Phone: 616-822-2334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT14971
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number103527
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: