Provider Demographics
NPI:1629033162
Name:REDIN, KARI JO (OTR)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:JO
Last Name:REDIN
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 1:17066 59TH ST NE
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55374-4714
Mailing Address - Country:US
Mailing Address - Phone:612-227-4081
Mailing Address - Fax:
Practice Address - Street 1:1130 LUND BLVD
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-1091
Practice Address - Country:US
Practice Address - Phone:612-227-4081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100034225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN20923002OtherMHP
131304OtherUCARE
MN926443400Medicaid
MN025T5REOtherBLUE CROSS BLUE SHIELD
670000101Medicare UPIN