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General NPI Number Information
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NPI Number | 1285192666
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Entity Type | Individual
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Provider Name | KRISTIN MARIE RIES OTD, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 03/05/2019
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Last Update Date | 03/05/2019
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Provider Practice Location Address
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Address Line | 6625 LYNDALE AVE S STE 430
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City | RICHFIELD
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State | MN
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Zip | 55423-2373
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Country | US
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Telephone | 952-285-2840
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Fax |
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Provider Business Mailing Address
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Address Line | 4033 87TH ST E
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City | INVER GROVE HEIGHTS
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State | MN
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Zip | 55076-3560
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Country | US
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Telephone | 612-749-4010
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 103852
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License Number State | MN
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