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NPI Code Detail

MEDICARE: KIMBERLY R PRITCHETT OTR/L

MEDICARE: KIMBERLY R PRITCHETT OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist104775MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1104775OTHERMNLICENSE

General Provider Information

NPI Number : 1013398312
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY R PRITCHETT OTR/L
Provider Business Mailing Address
First Line : 710 COMMERCE DR STE 200
Second Line :
City : WOODBURY
State : MN
Zip : 55125-4925
Country : US
Telephone Number : 651-968-5042
Fax Number : 651-968-5904
Provider Business Practice Location Address
First Line : 280 SMITH AVE N STE 500
Second Line :
City : SAINT PAUL
State : MN
Zip : 55102-2463
Country : US
Telephone Number : 651-968-5420
Fax Number : 651-222-0956
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2015
Last Update Date : 07/02/2015

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Directions to “ KIMBERLY R PRITCHETT OTR/L” Practice Location

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