Healthcare Provider Details

I. General information

NPI: 1255277521
Provider Name (Legal Business Name): MOLLI CACKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 SUNRISE DR SUITE B
ST PETER MN
56082
US

IV. Provider business mailing address

144 JACOB ST
HAMBURG MN
55339-9404
US

V. Phone/Fax

Practice location:
  • Phone: 507-934-3573
  • Fax: 507-934-4072
Mailing address:
  • Phone: 507-934-3573
  • Fax: 507-934-4072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number108089
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: