Provider Demographics
NPI:1740658343
Name:ROBERTS, KATELIN (OTR/L)
Entity type:Individual
Prefix:
First Name:KATELIN
Middle Name:
Last Name:ROBERTS
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 1:5441 NOKOMIS AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2060
Mailing Address - Country:US
Mailing Address - Phone:507-340-8479
Mailing Address - Fax:
Practice Address - Street 1:5441 NOKOMIS AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2060
Practice Address - Country:US
Practice Address - Phone:507-340-8479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-13
Last Update Date:2015-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104903225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist