Healthcare Provider Details

I. General information

NPI: 1073431813
Provider Name (Legal Business Name): RADIA MOTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17942 HAWKSBILL DR
LAKEVILLE MN
55044-4997
US

IV. Provider business mailing address

17942 HAWKSBILL DR
LAKEVILLE MN
55044-4997
US

V. Phone/Fax

Practice location:
  • Phone: 612-229-6298
  • Fax:
Mailing address:
  • Phone: 612-369-7570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number1115045
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: