Provider Demographics
NPI:1215033089
Name:SIEGAL, NAOMI LINDA (OTR)
Entity Type:Individual
Prefix:MS
First Name:NAOMI
Middle Name:LINDA
Last Name:SIEGAL
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 1:4205 10TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-4478
Mailing Address - Country:US
Mailing Address - Phone:612-250-5097
Mailing Address - Fax:
Practice Address - Street 1:2495 MAPLEWOOD DR N STE 313
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1985
Practice Address - Country:US
Practice Address - Phone:651-770-8884
Practice Address - Fax:651-770-8151
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101683225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6537260-00Medicaid
64-14663OtherMEDICA
127038OtherUCARE MINNESOTA
65Q73SIOtherBLUE CROSS BLUE SHIELD MN