Healthcare Provider Details

I. General information

NPI: 1073604831
Provider Name (Legal Business Name): ALLISON KROGSTAD OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON NETTESTAD

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 30TH AVE S
MOORHEAD MN
56560-5106
US

IV. Provider business mailing address

1313 30TH AVE S
MOORHEAD MN
56560-5106
US

V. Phone/Fax

Practice location:
  • Phone: 218-284-7112
  • Fax:
Mailing address:
  • Phone: 218-284-7112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number103025
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: