Healthcare Provider Details

I. General information

NPI: 1285806976
Provider Name (Legal Business Name): JENNICA A ELLIOTT OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1897 DELAWARE AVE
MENDOTA HEIGHTS MN
55118-4338
US

IV. Provider business mailing address

3748 RIDGEWOOD DR
EAGAN MN
55123-1321
US

V. Phone/Fax

Practice location:
  • Phone: 651-403-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number103107
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: