Provider Demographics
NPI:1881359362
Name:ENGEBRETSON, KATHLEEN (OTR)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:ENGEBRETSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3514 LYNDALE AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-2558
Mailing Address - Country:US
Mailing Address - Phone:612-803-5038
Mailing Address - Fax:763-559-7706
Practice Address - Street 1:3514 LYNDALE AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-2558
Practice Address - Country:US
Practice Address - Phone:612-803-5038
Practice Address - Fax:763-559-7706
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100087225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist