Healthcare Provider Details

I. General information

NPI: 1013409879
Provider Name (Legal Business Name): ELIZABETH ANN JESKA MA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 153RD ST W
ROSEMOUNT MN
55068-4946
US

IV. Provider business mailing address

3455 153RD ST W
ROSEMOUNT MN
55068-4946
US

V. Phone/Fax

Practice location:
  • Phone: 651-423-7700
  • Fax:
Mailing address:
  • Phone: 651-423-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number105675
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: