Healthcare Provider Details

I. General information

NPI: 1437882693
Provider Name (Legal Business Name): MARIAH LEE WINKELS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 HIGHWAY 169 N STE 100
NEW HOPE MN
55428-4044
US

IV. Provider business mailing address

4900 HIGHWAY 169 N STE 100
NEW HOPE MN
55428-4044
US

V. Phone/Fax

Practice location:
  • Phone: 612-877-8800
  • Fax: 612-877-8801
Mailing address:
  • Phone: 612-877-8800
  • Fax: 612-877-8801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number202682
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: