Healthcare Provider Details

I. General information

NPI: 1881716629
Provider Name (Legal Business Name): MICHELLE KAYE BEELER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE KAYE BERG OTR/L

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 FRANCE AVENUE SOUTH SUITE 305 CAPERNAUM PEDIATRIC THERAPY, INC.
EDINA MN
55435-4305
US

IV. Provider business mailing address

7250 FRANCE AVENUE SOUTH SUITE 305 CAPERNAUM PEDIATRIC THERAPY, INC.
EDINA MN
55435-4305
US

V. Phone/Fax

Practice location:
  • Phone: 952-285-2840
  • Fax: 952-285-2830
Mailing address:
  • Phone: 952-285-2840
  • Fax: 952-285-2830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number103177
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: