Provider Demographics
NPI:1942061015
Name:LINDHOLM RIDGEDELL, AMANDA LAUREN (OTR/L)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LAUREN
Last Name:LINDHOLM RIDGEDELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7433 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-4204
Mailing Address - Country:US
Mailing Address - Phone:952-334-1310
Mailing Address - Fax:
Practice Address - Street 1:7433 1ST AVE S
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-4204
Practice Address - Country:US
Practice Address - Phone:952-334-1310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105680225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist