MEDICARE: KRISTI ANN FICKES MOT, 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	104526	MN

General Provider Information

NPI Number	:	1548197361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI ANN FICKES MOT, OTR/L

Provider Business Mailing Address
First Line	:	2540 COUNTY ROAD F E
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55110-3935
Country	:	US
Telephone Number	:	651-415-5500
Fax Number	:

Provider Business Practice Location Address
First Line	:	3764 95TH AVE NE
Second Line	:
City	:	CIRCLE PINES
State	:	MN
Zip	:	55014-3849
Country	:	US
Telephone Number	:	651-415-6200
Fax Number	:

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

Provider Enumeration Date	:	05/06/2026
Last Update Date	:	05/06/2026

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