Provider Demographics
NPI:1730131384
Name:BIEBL, RENAE ELLEN (OT)
Entity Type:Individual
Prefix:
First Name:RENAE
Middle Name:ELLEN
Last Name:BIEBL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:RENAE
Other - Middle Name:ELLEN
Other - Last Name:SIEWERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8100 NORTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-4800
Mailing Address - Country:US
Mailing Address - Phone:952-831-8742
Mailing Address - Fax:952-831-1626
Practice Address - Street 1:8100 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-4800
Practice Address - Country:US
Practice Address - Phone:952-831-8742
Practice Address - Fax:952-831-1626
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102651225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6405992OtherMEDICA
MN320P4REOtherBLUECROSS BLUESHIELD
MN370487400Medicaid
MNHP51448OtherHEALTHPARTNERS
WI40899700Medicaid
MNHP51448OtherHEALTHPARTNERS