Healthcare Provider Details

I. General information

NPI: 1497812259
Provider Name (Legal Business Name): KRISTINE HULETT OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
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

18780 HUXLEY AVE
LAKEVILLE MN
55044-3605
US

V. Phone/Fax

Practice location:
  • Phone: 612-668-0254
  • Fax:
Mailing address:
  • Phone: 321-297-2720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number103743
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: