Provider Demographics
NPI:1457575672
Name:DANIELSON, KATHERINE E (OT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 MAIN STREET
Mailing Address - Street 2:PO BOX 40
Mailing Address - City:STARBUCK
Mailing Address - State:MN
Mailing Address - Zip Code:56381
Mailing Address - Country:US
Mailing Address - Phone:320-239-2217
Mailing Address - Fax:320-239-7144
Practice Address - Street 1:605 MAIN STREET
Practice Address - Street 2:
Practice Address - City:STARBUCK
Practice Address - State:MN
Practice Address - Zip Code:56381
Practice Address - Country:US
Practice Address - Phone:320-239-2217
Practice Address - Fax:320-239-7144
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102589174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP42792OtherHEALTH PARTNERS
MN01022435OtherPREFERRED ONE
MN290K9DAOtherBLUE CROSS BLUE SHIELD
MN030701011OtherPRIME WEST
MN328542100Medicaid
MN6404894OtherMEDICA
MN122234OtherUCARE
MN290K9DAOtherBLUE CROSS BLUE SHIELD