Healthcare Provider Details

I. General information

NPI: 1417460809
Provider Name (Legal Business Name): SAIGE AUTUMN BAKER-LIETZ MOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4148 WINNETKA AVE N
NEW HOPE MN
55427-1210
US

IV. Provider business mailing address

4148 WINNETKA AVE N
NEW HOPE MN
55427-1210
US

V. Phone/Fax

Practice location:
  • Phone: 763-504-8000
  • Fax:
Mailing address:
  • Phone: 763-504-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number105505
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: