Provider Demographics
NPI:1225200934
Name:ANHELUK, MATTIE LEE (MOT)
Entity Type:Individual
Prefix:MRS
First Name:MATTIE
Middle Name:LEE
Last Name:ANHELUK
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ABBOTT NORTHWESTERN HOSPITAL
Mailing Address - Street 2:800 E 28TH STREET
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3799
Mailing Address - Country:US
Mailing Address - Phone:612-562-2945
Mailing Address - Fax:126-863-8942
Practice Address - Street 1:333 SMITH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2344
Practice Address - Country:US
Practice Address - Phone:651-241-5488
Practice Address - Fax:651-241-7177
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103472225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN103472OtherOT PRACTICTIONER LICENSE