Provider Demographics
NPI:1073604831
Name:KROGSTAD, ALLISON (OTR)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:KROGSTAD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:NETTESTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1108 140TH ST
Mailing Address - Street 2:
Mailing Address - City:PERLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56574-9531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:133 4TH AVE E
Practice Address - Street 2:
Practice Address - City:HALSTAD
Practice Address - State:MN
Practice Address - Zip Code:56548-4114
Practice Address - Country:US
Practice Address - Phone:763-689-5385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103025225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP45790OtherHEALTH PARTNERS
MN6405128OtherMEDICA
MN441T0KROtherBCBS
ND24956OtherBCBS
MN441T0KROtherBCBS