Provider Demographics
NPI:1528585411
Name:KOEZLY ESCOBAR, CLARE T (OTD, OTR)
Entity Type:Individual
Prefix:DR
First Name:CLARE
Middle Name:T
Last Name:KOEZLY ESCOBAR
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5868 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-5903
Mailing Address - Country:US
Mailing Address - Phone:952-767-4200
Mailing Address - Fax:952-767-4211
Practice Address - Street 1:5868 BAKER RD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-5903
Practice Address - Country:US
Practice Address - Phone:952-767-4200
Practice Address - Fax:952-767-4211
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105463225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN105463OtherOCCUPATIONAL THERAPIST LICENSE
387141OtherNBCOT