MEDICARE: LAURA JEAN DICKASON-SOPETH OTR

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	100665	MN

General Provider Information

NPI Number	:	1104624550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA JEAN DICKASON-SOPETH OTR

Provider Business Mailing Address
First Line	:	17420 IXONIA CT
Second Line	:
City	:	LAKEVILLE
State	:	MN
Zip	:	55044-8741
Country	:	US
Telephone Number	:	612-280-3514
Fax Number	:

Provider Business Practice Location Address
First Line	:	8758 EGAN DR
Second Line	:
City	:	SAVAGE
State	:	MN
Zip	:	55378-2561
Country	:	US
Telephone Number	:	952-473-9888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2025
Last Update Date	:	03/03/2025

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Directions to “ LAURA JEAN DICKASON-SOPETH OTR” Practice Location

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