Healthcare Provider Details

I. General information

NPI: 1376541243
Provider Name (Legal Business Name): METRO THERAPY SPECIAL CHILDREN'S CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5155 E RIVER RD SUITE 403
FRIDLEY MN
55421-1025
US

IV. Provider business mailing address

5155 E RIVER RD SUITE 403
FRIDLEY MN
55421-1025
US

V. Phone/Fax

Practice location:
  • Phone: 763-572-2519
  • Fax: 763-572-2616
Mailing address:
  • Phone: 763-572-2519
  • Fax: 763-572-2616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateMN

VIII. Authorized Official

Name: MS. AUDREY MARIE CHAPUT
Title or Position: PRESIDENT
Credential: OTR/C
Phone: 763-572-2519