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NPI Code Detail

MEDICARE: CARISA BETHANY HRUBETZ OT

MEDICARE: CARISA BETHANY HRUBETZ OT
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 TherapistOT-105351MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2OT-105351OTHERMNSTATE LICENSE

General Provider Information

NPI Number : 1962992156
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARISA BETHANY HRUBETZ OT
Provider Business Mailing Address
First Line : 11800 XEON BLVD NW
Second Line :
City : COON RAPIDS
State : MN
Zip : 55448-2099
Country : US
Telephone Number : 763-755-8400
Fax Number : 763-755-8578
Provider Business Practice Location Address
First Line : 11800 XEON BLVD NW
Second Line :
City : COON RAPIDS
State : MN
Zip : 55448-2061
Country : US
Telephone Number : 763-755-8400
Fax Number : 763-755-8575
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2018
Last Update Date : 01/16/2020

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Directions to “ CARISA BETHANY HRUBETZ OT” Practice Location

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