Provider Demographics
NPI:1013975663
Name:HAROLDSON, RENEE (OTRL CHT)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:
Last Name:HAROLDSON
Suffix:
Gender:F
Credentials:OTRL CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14500 99TH AVE N
Mailing Address - Street 2:#1-210
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4730
Mailing Address - Country:US
Mailing Address - Phone:763-898-1778
Mailing Address - Fax:763-898-1771
Practice Address - Street 1:14500 99TH AVE N
Practice Address - Street 2:#1-210
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4730
Practice Address - Country:US
Practice Address - Phone:763-898-1778
Practice Address - Fax:763-898-1771
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103981225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA192940OtherBCBS OCCUPATIONAL THERAPY
VA670001766OtherRAILROAD MEDICARE
VA8937141Medicaid
7601113OtherAETNA
VA8937141Medicaid
VAC05954Medicare PIN
VAC06705Medicare PIN
VAMC10528Medicare PIN