Healthcare Provider Details

I. General information

NPI: 1629931852
Provider Name (Legal Business Name): KRISTINA KLIMMEK QUIRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 W BROADWAY AVE
MINNEAPOLIS MN
55411-2533
US

IV. Provider business mailing address

4716 CLINTON AVE
MINNEAPOLIS MN
55419-5657
US

V. Phone/Fax

Practice location:
  • Phone: 612-668-0254
  • Fax:
Mailing address:
  • Phone: 612-644-4551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number105749
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: