Provider Demographics
NPI:1073693511
Name:VREEMAN, AMBER (OTR)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:VREEMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10557 W RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1231
Mailing Address - Country:US
Mailing Address - Phone:612-743-0350
Mailing Address - Fax:
Practice Address - Street 1:10557 W RIVER RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1231
Practice Address - Country:US
Practice Address - Phone:612-743-0350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102318225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN31P35LEOtherBCBS PROVIDER ID
MN088405700Medicaid
MN670000073Medicare ID - Type Unspecified