DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: THEA RENEE FREDERICKSEN M.A., OTR/L

MEDICARE: THEA RENEE FREDERICKSEN M.A., 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 Therapist104473MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1309557OTHERMNNATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY
2104473OTHERMNMN OT LICENSE

General Provider Information

NPI Number : 1598178204
Entity Type Code : Individual
Provider Name (Legal Business Name) : THEA RENEE FREDERICKSEN M.A., 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 : 1250 W BROADWAY AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55411-2533
Country : US
Telephone Number : 612-668-0254
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2014
Last Update Date : 06/08/2026

Similar Medicare Providers

1346206729 — DR. ANDREA ERICKSON OTR
Practice Location Address:
1250 W BROADWAY AVE
MINNEAPOLIS, MN
55411-2533
Practice Phone: 612-668-0000
Practice Fax:
1265499818 — MARYANN BURKE DE RUITER PT
Practice Location Address:
1250 W BROADWAY AVE
MINNEAPOLIS, MN
55411-2533
Practice Phone: 612-517-5817
Practice Fax:
1518071307 — MS. KATHERINE SATHER NOVAK OTRL
Practice Location Address:
1250 W BROADWAY AVE
MINNEAPOLIS, MN
55411-2533
Practice Phone: 612-517-5756
Practice Fax:
1871608737 — DR. JESSICA ANNE OVANS PT
Practice Location Address:
1250 W BROADWAY AVE
MINNEAPOLIS, MN
55411-2533
Practice Phone: 612-668-0254
Practice Fax:
1164534707 — CARRIE B. BOOTH OTR/L
Practice Location Address:
1250 W BROADWAY AVE
MINNEAPOLIS, MN
55411-2533
Practice Phone: 612-668-0254
Practice Fax:
1487759072 — MRS. KATHERINE CHAMBERLAIN MS, CCC-SLP
Practice Location Address:
1250 W BROADWAY AVE
MINNEAPOLIS, MN
55411-2533
Practice Phone: 612-668-0254
Practice Fax: 715-386-6119

Directions to “ THEA RENEE FREDERICKSEN M.A., OTR/L” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.