Provider Demographics
NPI:1710690300
Name:VAN LANEN, PAIGE (COTA/L)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:VAN LANEN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 SAINT FRANCIS WAY APT E
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-1168
Mailing Address - Country:US
Mailing Address - Phone:651-328-9871
Mailing Address - Fax:
Practice Address - Street 1:16258 KENYON AVE
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-4665
Practice Address - Country:US
Practice Address - Phone:952-915-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN202732224Z00000X
480887224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant