Provider Demographics
NPI:1497372684
Name:NIEMELA, SHARI ANN
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:ANN
Last Name:NIEMELA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHARI
Other - Middle Name:
Other - Last Name:SEIFERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2653 COUNTY ROAD 74
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-2205
Mailing Address - Country:US
Mailing Address - Phone:320-224-4069
Mailing Address - Fax:
Practice Address - Street 1:2653 COUNTY ROAD 74
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-2205
Practice Address - Country:US
Practice Address - Phone:320-224-4069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-03
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106267225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist