MEDICARE: SARAH ELIZABETH LANOUE 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
1	225XP0200X	Pediatric Occupational Therapist	105901	MN

General Provider Information

NPI Number	:	1295399426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ELIZABETH LANOUE OTR/L

Provider Business Mailing Address
First Line	:	1250 W BROADWAY AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-2533
Country	:	US
Telephone Number	:	612-668-0254
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 GLENWOOD AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55405-1259
Country	:	US
Telephone Number	:	612-668-2884
Fax Number	:

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

Provider Enumeration Date	:	04/23/2019
Last Update Date	:	04/17/2026

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