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General NPI Number Information
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NPI Number | 1225907090
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Entity Type | Individual
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Provider Name | SETH KIRKEIDE
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Gender | Male
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Dates
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Enumeration Date | 10/31/2025
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 13305 12TH AVE N
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City | PLYMOUTH
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State | MN
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Zip | 55441-4527
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Country | US
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Telephone | 763-745-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 2824 SHERWOOD RD
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City | SAINT PAUL
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State | MN
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Zip | 55112-5837
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 107046
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License Number State | MN
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