Healthcare Provider Details

I. General information

NPI: 1356468953
Provider Name (Legal Business Name): KELLY MARGARET FLANAGAN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 EAST 28TH STREET
MINNEAPOLIS MN
55407
US

IV. Provider business mailing address

15480 OMEGA TRAIL SOUTHEAST
PRIOR LAKE MN
55372
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-7631
  • Fax:
Mailing address:
  • Phone: 952-447-1172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number100403
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: