Healthcare Provider Details

I. General information

NPI: 1477506269
Provider Name (Legal Business Name): ALISA N KOCIAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 CURVE CREST BLVD COURAGE CENTER
STILLWATER MN
55082
US

IV. Provider business mailing address

1460 CURVE CREST BLVD COURAGE CENTER
STILLWATER MN
55082
US

V. Phone/Fax

Practice location:
  • Phone: 651-351-2341
  • Fax: 651-439-8283
Mailing address:
  • Phone: 651-351-3368
  • Fax: 651-351-3383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number102904
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: