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General NPI Number Information
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NPI Number | 1326754938
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Entity Type | Individual
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Provider Name | KATELYN ROSE MCLELLAN OTD, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 01/26/2023
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Last Update Date | 01/26/2023
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Provider Practice Location Address
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Address Line | 2101 WOODDALE DR STE A
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City | WOODBURY
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State | MN
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Zip | 55125-2933
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Country | US
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Telephone | 651-738-9888
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Fax |
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Provider Business Mailing Address
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Address Line | 7577 IVYSTONE AVE S
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-2138
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Country | US
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Telephone | 715-222-5700
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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 | 107052
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License Number State | MN
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