Healthcare Provider Details

I. General information

NPI: 1306775192
Provider Name (Legal Business Name): MICHELLE A MAKRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5621 COUNTY ROAD 101
MINNETONKA MN
55345-4214
US

IV. Provider business mailing address

7008 NEWTON AVE S
RICHFIELD MN
55423-2945
US

V. Phone/Fax

Practice location:
  • Phone: 952-401-5000
  • Fax:
Mailing address:
  • Phone: 612-940-7949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number101431
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: