Healthcare Provider Details

I. General information

NPI: 1508656331
Provider Name (Legal Business Name): ELIZABETH ELLINGSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ANN KUESTER OTR/L

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5803 NEAL AVE N
STILLWATER MN
55082-2177
US

IV. Provider business mailing address

5803 NEAL AVE N
STILLWATER MN
55082-2177
US

V. Phone/Fax

Practice location:
  • Phone: 651-472-6107
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number103230
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: