MEDICARE: THRIVING SPIRIT LIFESTYLE MEDICINE LLC

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
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1043153539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVING SPIRIT LIFESTYLE MEDICINE LLC

Provider Business Mailing Address
First Line	:	110 OAK ST N
Second Line	:
City	:	CHASKA
State	:	MN
Zip	:	55318-2934
Country	:	US
Telephone Number	:	952-356-9945
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 OAK ST N
Second Line	:
City	:	CHASKA
State	:	MN
Zip	:	55318-2934
Country	:	US
Telephone Number	:	952-356-9945
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ADRIENNE DEMBINSKI
Credential	:	OTD, OTR/L
Telephone Number	:	952-356-9945

Provider Enumeration Date	:	04/10/2026
Last Update Date	:	04/10/2026

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