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NPI Code Detail

MEDICARE: KELLY SUE CHAN MA, OTR/L

MEDICARE: KELLY SUE CHAN MA, 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 TherapistMN

General Provider Information

NPI Number : 1336094713
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY SUE CHAN MA, OTR/L
Provider Business Mailing Address
First Line : 421 WALNUT ST
Second Line :
City : FARMINGTON
State : MN
Zip : 55024-1344
Country : US
Telephone Number : 612-252-2980
Fax Number : 651-460-3830
Provider Business Practice Location Address
First Line : 421 WALNUT ST
Second Line :
City : FARMINGTON
State : MN
Zip : 55024-1344
Country : US
Telephone Number : 612-252-2980
Fax Number : 651-460-3830
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2026
Last Update Date : 03/02/2026

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Directions to “ KELLY SUE CHAN MA, OTR/L” Practice Location

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