Provider Demographics
NPI:1881716629
Name:BEELER, MICHELLE KAYE (OTR/L)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KAYE
Last Name:BEELER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:KAYE
Other - Last Name:BERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:7250 FRANCE AVENUE SOUTH
Mailing Address - Street 2:SUITE 305 CAPERNAUM PEDIATRIC THERAPY, INC.
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4305
Mailing Address - Country:US
Mailing Address - Phone:952-285-2840
Mailing Address - Fax:952-285-2830
Practice Address - Street 1:7250 FRANCE AVENUE SOUTH
Practice Address - Street 2:SUITE 305 CAPERNAUM PEDIATRIC THERAPY, INC.
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4305
Practice Address - Country:US
Practice Address - Phone:952-285-2840
Practice Address - Fax:952-285-2830
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103177225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics