Healthcare Provider Details

I. General information

NPI: 1386157337
Provider Name (Legal Business Name): CHELSEA LEE PAYNE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2017
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

6504 MORGAN AVE S
RICHFIELD MN
55423-1108
US

V. Phone/Fax

Practice location:
  • Phone: 651-683-6801
  • Fax:
Mailing address:
  • Phone: 952-200-1696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number105461
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: