Provider Demographics
NPI:1205357100
Name:ENGEBRETSON, ALLISON RAE (MOT, OTR/L)
Entity type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:RAE
Last Name:ENGEBRETSON
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:RAE
Other - Last Name:LASKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:1852 EVERGREEN DRAW
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2306
Mailing Address - Country:US
Mailing Address - Phone:651-230-3130
Mailing Address - Fax:
Practice Address - Street 1:1852 EVERGREEN DRAW
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2306
Practice Address - Country:US
Practice Address - Phone:651-230-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT3285225X00000X
MN105217225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist