Healthcare Provider Details

I. General information

NPI: 1891977849
Provider Name (Legal Business Name): BETHANY LEIGH CHRISTIANSON OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2007
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 BISCAYNE AVE W
ROSEMOUNT MN
55068-4909
US

IV. Provider business mailing address

1524 RIVER TER
PRESCOTT WI
54021-7046
US

V. Phone/Fax

Practice location:
  • Phone: 651-429-8100
  • Fax:
Mailing address:
  • Phone: 715-307-3086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4360-026
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: