Healthcare Provider Details

I. General information

NPI: 1396676532
Provider Name (Legal Business Name): KATRINA GEARHART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 2ND ST S
WAITE PARK MN
56387-2325
US

IV. Provider business mailing address

7307 337TH AVE NW
PRINCETON MN
55371-4920
US

V. Phone/Fax

Practice location:
  • Phone: 320-370-8000
  • Fax:
Mailing address:
  • Phone: 763-354-8933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number103775
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: