Provider Demographics
NPI:1952498214
Name:COPPICUS, KATRINA (OTR)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:COPPICUS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:DAHIETL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1575 AMBER DR
Mailing Address - Street 2:#206
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:230 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:MN
Practice Address - Zip Code:56307
Practice Address - Country:US
Practice Address - Phone:763-689-5385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103150225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN082H9DAOtherBLUE CROSS BLUE SHIELD
MN6405972OtherMEDICA
MNHP56644OtherHEALTH PARTNERS
MNHP56644OtherHEALTH PARTNERS