Healthcare Provider Details

I. General information

NPI: 1720982721
Provider Name (Legal Business Name): HEATHER ANDERSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4634 BLUEBELL TRL N
MEDINA MN
55340-4573
US

IV. Provider business mailing address

4634 BLUEBELL TRL N
MEDINA MN
55340-4573
US

V. Phone/Fax

Practice location:
  • Phone: 612-790-0042
  • Fax:
Mailing address:
  • Phone: 612-790-0042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number104665
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: