Healthcare Provider Details

I. General information

NPI: 1760256267
Provider Name (Legal Business Name): MICHAEL AUSEN OTD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MIKE AUSEN

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 28TH ST
MINNEAPOLIS MN
55407-3723
US

IV. Provider business mailing address

7906 CLAIBORNE LN
INVER GROVE HEIGHTS MN
55076-3040
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-6015
  • Fax:
Mailing address:
  • Phone: 651-271-9475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: